Basic Information
| Provider Information | |||||||||
| NPI: | 1427350776 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIALIZED MEDICAL CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 E CHICAGO AVE | ||||||||
| Address2: | SUITE 1050 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307180200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 E CHICAGO AVE | ||||||||
| Address2: | SUITE 1050 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123372288 | ||||||||
| FaxNumber: | 3123372288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2010 | ||||||||
| LastUpdateDate: | 11/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | OYER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6307180200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 036050957 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.