Provider Demographics
NPI:1134265994
Name:PULMONARY PROVIDERS GROUP, INC.
Entity type:Organization
Organization Name:PULMONARY PROVIDERS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERZY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-226-3049
Mailing Address - Street 1:4521 W. LAWRENCE AVE.
Mailing Address - Street 2:STE.110
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2585
Mailing Address - Country:US
Mailing Address - Phone:847-824-0500
Mailing Address - Fax:847-824-0529
Practice Address - Street 1:4521 W.LAWRENCE AVE
Practice Address - Street 2:STE.110
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2585
Practice Address - Country:US
Practice Address - Phone:847-824-0500
Practice Address - Fax:847-824-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL5911820001Medicare NSC