Provider Demographics
NPI:1972726701
Name:CERMAK HEALTH SERVICES
Entity Type:Organization
Organization Name:CERMAK HEALTH SERVICES
Other - Org Name:CORE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PA-C PHYSICIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRZEKOP
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C PHYSICIST
Authorized Official - Phone:773-869-2954
Mailing Address - Street 1:950 WEST LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1718
Mailing Address - Country:US
Mailing Address - Phone:773-869-2954
Mailing Address - Fax:
Practice Address - Street 1:2800 SOUTH CALIFORNIA AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:773-869-2954
Practice Address - Fax:773-869-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001311363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty