Unknown Individual – Internal Medicine Physician, NPI 1609877810

Unknown Individual is a healthcare provider. based in Chicago, Illinois. specializing in Internal Medicine Physician. The NPI Number for Unknown Individual is 1609877810

Main info

Organization
Inactive
61 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1609877810
Phone
(773) 995-3454
Address
67 W 111TH ST
Deactivation Date
30 November 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1965 (61 years ago)
PAC ID
2466503008
Professional Enrollment ID
I20090622000617
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience5
Completeness75
Years active:0State licenses:0Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 67, West 111th Street, Roseland, Morgan Park, Chicago, Lake Township, Cook County, Illinois, 60628, United States

    CHICAGO, IL 606284247

    Phone: (773) 995-3454

    Type: Location

  • 9526, South Kilbourn Avenue, Oak Lawn, Worth Township, Cook County, Illinois, 60453, United States

    OAK LAWN, IL 604533208

    Phone: (773) 995-3454

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60628)

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Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1609877810; it appears in the national provider directory.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Illinois?
You will see Chicago, Illinois on file for Unknown Individual alongside any extra practice locations.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1609877810. Always confirm identity and privileges with the practice and licensing boards.

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