Provider Demographics
NPI:1811944788
Name:SUMMIT MEDICAL CARE, LLC
Entity type:Organization
Organization Name:SUMMIT MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COSME
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-505-3830
Mailing Address - Street 1:640 S WASHINGTON ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6603
Mailing Address - Country:US
Mailing Address - Phone:331-457-5737
Mailing Address - Fax:
Practice Address - Street 1:640 S WASHINGTON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6603
Practice Address - Country:US
Practice Address - Phone:331-457-5737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL142659Medicare Oscar/Certification