Provider Demographics
NPI:1972070605
Name:SENIORCARE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:SENIORCARE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYIBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:224-357-6997
Mailing Address - Street 1:2160 COLCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-4164
Mailing Address - Country:US
Mailing Address - Phone:224-357-6997
Mailing Address - Fax:224-227-7312
Practice Address - Street 1:746 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-1424
Practice Address - Country:US
Practice Address - Phone:847-697-0565
Practice Address - Fax:847-697-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty