Provider Demographics
NPI:1356609598
Name:PRIMA MEDICUS LLC
Entity type:Organization
Organization Name:PRIMA MEDICUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:V
Authorized Official - Last Name:ESTOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:773-800-1771
Mailing Address - Street 1:6007 N SHERIDAN RD APT 15K
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-3063
Mailing Address - Country:US
Mailing Address - Phone:773-800-1771
Mailing Address - Fax:888-359-3421
Practice Address - Street 1:6007 N SHERIDAN RD APT 15K
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3063
Practice Address - Country:US
Practice Address - Phone:773-800-1771
Practice Address - Fax:888-359-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty