Basic Information
| Provider Information | |||||||||
| NPI: | 1376533380 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMARY CARE PARTNERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 77-52157 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606780001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087475850 | ||||||||
| FaxNumber: | 7087479991 | ||||||||
| Practice Location | |||||||||
| Address1: | 16650 HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | TINLEY PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604771847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083423000 | ||||||||
| FaxNumber: | 7083423040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| AuthorizedOfficialLastName: | RAHMANI | ||||||||
| AuthorizedOfficialFirstName: | AKBAR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7083423000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207RE0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RN0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01619268 | 01 | BCBS OF ILLINOIS NUMBER | OTHER |