Basic Information
| Provider Information | |||||||||
| NPI: | 1821237199 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MDRX MEDICAL,P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7 | ||||||||
| Address2: | |||||||||
| City: | CLARENDON HILLS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605140007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087557850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 E 15TH ST | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | CHICAGO HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604113459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087559355 | ||||||||
| FaxNumber: | 7087557851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | CHUGH | ||||||||
| AuthorizedOfficialFirstName: | RAKESH | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7087559355 | ||||||||
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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 | 207Q00000X | 036085688 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036085688 | 05 | IL | MEDICAID |