Provider Demographics
NPI:1356553036
Name:ONE MAG MILE ASSOCIATES, INC.
Entity type:Organization
Organization Name:ONE MAG MILE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAGWAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHAHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-587-9123
Mailing Address - Street 1:950 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 4305
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4509
Mailing Address - Country:US
Mailing Address - Phone:312-587-9123
Mailing Address - Fax:312-944-4954
Practice Address - Street 1:11012 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-238-5300
Practice Address - Fax:773-238-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635370OtherBLUE CROSS BLUE SHIELD
IL1635370OtherBLUE CROSS BLUE SHIELD