Provider Demographics
NPI:1295332104
Name:PRIMA MEDICAL PRACTICES INC
Entity type:Organization
Organization Name:PRIMA MEDICAL PRACTICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-897-9010
Mailing Address - Street 1:541 HELEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2527
Mailing Address - Country:US
Mailing Address - Phone:847-897-9010
Mailing Address - Fax:
Practice Address - Street 1:1875 DEMPSTER ST STE 110
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1125
Practice Address - Country:US
Practice Address - Phone:847-897-9010
Practice Address - Fax:847-692-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-04
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty