Provider Demographics
NPI:1942489075
Name:DEERPATH PHYSICIANS GROUP LTD
Entity Type:Organization
Organization Name:DEERPATH PHYSICIANS GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-566-3337
Mailing Address - Street 1:731 S. ILLINOIS ROUTE 21
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3813
Mailing Address - Country:US
Mailing Address - Phone:847-566-3337
Mailing Address - Fax:847-816-3166
Practice Address - Street 1:731 S ILLINOIS ROUTE 21
Practice Address - Street 2:SUITE 130
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3813
Practice Address - Country:US
Practice Address - Phone:847-566-3337
Practice Address - Fax:847-816-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04930281OtherBLUE CROSS BLUE SHIELD
IL916950Medicare PIN