Provider Demographics
NPI:1356396758
Name:ELMWOOD PARK IMMEDIATE HEALTH CARE CENTER, LLC
Entity type:Organization
Organization Name:ELMWOOD PARK IMMEDIATE HEALTH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRZOSTOWSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-637-1700
Mailing Address - Street 1:2333 N. HARLEM AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-2718
Mailing Address - Country:US
Mailing Address - Phone:773-637-2333
Mailing Address - Fax:773-637-4229
Practice Address - Street 1:2333 N. HARLEM AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-2718
Practice Address - Country:US
Practice Address - Phone:773-637-2333
Practice Address - Fax:773-637-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634215OtherBCBS GROUP NUMBER
IL01634215OtherBCBS GROUP NUMBER