Provider Demographics
NPI:1851506588
Name:RHEUMATOLOGY SPECIALIST PC
Entity Type:Organization
Organization Name:RHEUMATOLOGY SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-450-5085
Mailing Address - Street 1:675 W NORTH AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1623
Mailing Address - Country:US
Mailing Address - Phone:708-450-5085
Mailing Address - Fax:708-344-3909
Practice Address - Street 1:675 W NORTH AVE STE 305
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1623
Practice Address - Country:US
Practice Address - Phone:708-450-5085
Practice Address - Fax:708-344-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076312Medicaid
IL036076312Medicaid