Provider Demographics
NPI:1245516939
Name:OPEN DOOR CLINIC
Entity type:Organization
Organization Name:OPEN DOOR CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-264-1819
Mailing Address - Street 1:164 DIVISION ST
Mailing Address - Street 2:STE #607
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-5587
Mailing Address - Country:US
Mailing Address - Phone:847-695-1093
Mailing Address - Fax:847-695-0501
Practice Address - Street 1:157 S LINCOLN AVE
Practice Address - Street 2:STE. #K
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60505-4264
Practice Address - Country:US
Practice Address - Phone:630-264-1819
Practice Address - Fax:630-264-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL702000Medicare PIN