Basic Information
| Provider Information | |||||||||
| NPI: | 1154564110 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHPARTNERS MEDICAL GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35294 EAGLE WAY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606781352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198796531 | ||||||||
| FaxNumber: | 2198727869 | ||||||||
| Practice Location | |||||||||
| Address1: | 2307 LAPORTE AVE | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463836997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2194768855 | ||||||||
| FaxNumber: | 2194768840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2009 | ||||||||
| LastUpdateDate: | 08/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | DONNELLY | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2198732905 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEALTHPARTNERS MEDICAL GROUP, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.