Provider Demographics
NPI:1922037720
Name:PATRICIA A LARSON MD & ASSOCIATES
Entity Type:Organization
Organization Name:PATRICIA A LARSON MD & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-690-9767
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:ITASCA
Mailing Address - State:IL
Mailing Address - Zip Code:60143-0529
Mailing Address - Country:US
Mailing Address - Phone:847-690-9767
Mailing Address - Fax:847-690-9872
Practice Address - Street 1:901 BIESTERFIELD RD STE 213
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007
Practice Address - Country:US
Practice Address - Phone:847-690-9767
Practice Address - Fax:847-690-9872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-050093207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID01633976OtherBLUE CROSS
IL5927730001Medicare NSC
IL212087Medicare ID - Type UnspecifiedGROUP
ID01633976OtherBLUE CROSS