Provider Demographics
NPI:1780756916
Name:INDEPENDENT PHYSICIANS AT MERCY
Entity type:Organization
Organization Name:INDEPENDENT PHYSICIANS AT MERCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JERE
Authorized Official - Middle Name:
Authorized Official - Last Name:FREIDHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-567-2156
Mailing Address - Street 1:2525 S MICHIGAN AVE
Mailing Address - Street 2:RM 2-601
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2333
Mailing Address - Country:US
Mailing Address - Phone:312-567-2156
Mailing Address - Fax:312-328-7829
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:RM 2-601
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2156
Practice Address - Fax:312-328-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL56353046302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization