Unknown Individual – Internal Medicine Physician, NPI 1154346013
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
2160, South 1st Avenue, Maywood, Proviso Township, Cook County, Illinois, 60153, United States
BLDG 101, ROOM 1752
MAYWOOD, IL 601533328
Phone: (708) 216-8786
Fax: (708) 216-4878
Type: Mailing
7255, West Grand Avenue, Ellsworth, Elmwood Park, Leyden Township, Cook County, Illinois, 60707, United States
ELMWOOD PARK, IL 607072028
Phone: (708) 456-4944
Fax: (708) 456-7841
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60153)
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