Provider Demographics
NPI:1972687481
Name:REGENCY MEDICAL CENTER, P.C.
Entity Type:Organization
Organization Name:REGENCY MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NADER
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-863-8964
Mailing Address - Street 1:22285 N PEPPER RD STE 302
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2541
Mailing Address - Country:US
Mailing Address - Phone:847-726-0774
Mailing Address - Fax:847-239-7919
Practice Address - Street 1:22285 N PEPPER RD STE 302
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2541
Practice Address - Country:US
Practice Address - Phone:847-726-0774
Practice Address - Fax:847-239-7919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205561Medicare ID - Type UnspecifiedGROUP PROVIDER # LAKE COU