Basic Information
| Provider Information | |||||||||
| NPI: | 1518473800 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIMARY CARE SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2740 W FOSTER AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606253547 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2740 W FOSTER AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606253547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737842101 | ||||||||
| FaxNumber: | 7737840771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2017 | ||||||||
| LastUpdateDate: | 12/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | HUMAYUN | ||||||||
| AuthorizedOfficialFirstName: | IRUM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7737842101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036127018 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.