Provider Demographics
NPI:1013930353
Name:PHYSICIAN ASSOCIATES LIMITED
Entity type:Organization
Organization Name:PHYSICIAN ASSOCIATES LIMITED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICHALSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-229-2500
Mailing Address - Street 1:1848 DAIMLER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61112-1019
Mailing Address - Country:US
Mailing Address - Phone:815-229-2500
Mailing Address - Fax:815-316-1881
Practice Address - Street 1:1848 DAIMLER RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1019
Practice Address - Country:US
Practice Address - Phone:815-229-2500
Practice Address - Fax:815-398-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL745670Medicare PIN
ILC42327Medicare UPIN