Basic Information
| Provider Information | |||||||||
| NPI: | 1063659654 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | C & R MEDICAL GROUP, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 66542 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606660542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309521412 | ||||||||
| FaxNumber: | 6309521447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 COPPERFIELD AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604322056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157740548 | ||||||||
| FaxNumber: | 8157740573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2009 | ||||||||
| LastUpdateDate: | 01/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | SINGH | ||||||||
| AuthorizedOfficialFirstName: | JITENDER | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6309521412 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036089209 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.