Provider Demographics
NPI:1871689208
Name:NOVA MEDICO S.C.
Entity Type:Organization
Organization Name:NOVA MEDICO S.C.
Other - Org Name:CHICAGO WOUND CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOGIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-296-6161
Mailing Address - Street 1:PO BOX 1124
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-1124
Mailing Address - Country:US
Mailing Address - Phone:847-296-6161
Mailing Address - Fax:847-574-7487
Practice Address - Street 1:1420 RENAISSANCE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1330
Practice Address - Country:US
Practice Address - Phone:847-296-6161
Practice Address - Fax:847-574-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360923022081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL981860Medicare PIN
IL201874Medicare PIN