Provider Demographics
NPI:1952439119
Name:PRAIRIE MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:PRAIRIE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-842-4400
Mailing Address - Street 1:2850 S WABASH AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2955
Mailing Address - Country:US
Mailing Address - Phone:312-842-4400
Mailing Address - Fax:312-842-4595
Practice Address - Street 1:2850 S WABASH AVE
Practice Address - Street 2:STE 106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2955
Practice Address - Country:US
Practice Address - Phone:312-842-4400
Practice Address - Fax:312-842-4595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12214Medicare UPIN
ILL38736Medicare ID - Type Unspecified