Provider Demographics
NPI:1780751313
Name:PREFERRED PHYSICIAN MEDICAL GROUP,LTD
Entity type:Organization
Organization Name:PREFERRED PHYSICIAN MEDICAL GROUP,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROULIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-540-0642
Mailing Address - Street 1:2110 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-7272
Mailing Address - Country:US
Mailing Address - Phone:773-235-7455
Mailing Address - Fax:773-235-7055
Practice Address - Street 1:2110 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-7272
Practice Address - Country:US
Practice Address - Phone:773-235-7455
Practice Address - Fax:773-235-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty