Provider Demographics
NPI:1922165919
Name:HARVEY L. ECHOLS, MD, PC
Entity Type:Organization
Organization Name:HARVEY L. ECHOLS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ECHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-450-4231
Mailing Address - Street 1:8170 MCCORMICK BLVD
Mailing Address - Street 2:PMS, SUITE 204
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2961
Mailing Address - Country:US
Mailing Address - Phone:847-410-2029
Mailing Address - Fax:847-410-2041
Practice Address - Street 1:8170 MCCORMICK BLVD
Practice Address - Street 2:PMS, SUITE 204
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2961
Practice Address - Country:US
Practice Address - Phone:847-410-2029
Practice Address - Fax:847-410-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-078648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214461Medicare PIN