Provider Demographics
NPI:1205814118
Name:PHYSICIANS IMMEDIATE CARE NORTH CHICAGO LLC
Entity type:Organization
Organization Name:PHYSICIANS IMMEDIATE CARE NORTH CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERNBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:585-430-8600
Mailing Address - Street 1:PO BOX 10157
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-5157
Mailing Address - Country:US
Mailing Address - Phone:716-699-9032
Mailing Address - Fax:315-928-1939
Practice Address - Street 1:4211 N CICERO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1651
Practice Address - Country:US
Practice Address - Phone:815-713-2738
Practice Address - Fax:815-986-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4764830003Medicare NSC
IL4764830004Medicare NSC
IL204591Medicare PIN
IL4764830001Medicare NSC
IL4764830002Medicare NSC
IL4764830004Medicare NSC