Provider Demographics
NPI:1922290980
Name:PRIME HEALTH CARE, LTD
Entity Type:Organization
Organization Name:PRIME HEALTH CARE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODARKOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-970-9922
Mailing Address - Street 1:333 EAST IL ROUTE 83
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060
Mailing Address - Country:US
Mailing Address - Phone:847-970-9922
Mailing Address - Fax:847-970-9955
Practice Address - Street 1:333 EAST IL ROUTE 83
Practice Address - Street 2:SUITE 105
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060
Practice Address - Country:US
Practice Address - Phone:847-970-9922
Practice Address - Fax:847-970-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service