Provider Demographics
NPI:1831280783
Name:HEALTHGUARD MEDICAL NETWORK SC
Entity Type:Organization
Organization Name:HEALTHGUARD MEDICAL NETWORK SC
Other - Org Name:HEALTHGUARD PEDIATRIC AND ADULT MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFARLOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-907-6009
Mailing Address - Street 1:1205 OAK STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-2006
Mailing Address - Country:US
Mailing Address - Phone:630-907-6009
Mailing Address - Fax:630-907-1890
Practice Address - Street 1:40W222 LA FOX ROAD
Practice Address - Street 2:SUITE K
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-7625
Practice Address - Country:US
Practice Address - Phone:630-443-7000
Practice Address - Fax:630-443-7590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
213057Medicare PIN
ILG5729Medicare UPIN