Basic Information
| Provider Information | |||||||||
| NPI: | 1952676405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIOR CARE PHYSICIANS OF ILLINOIS, S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 HARGER RD STE 408 | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304728800 | ||||||||
| FaxNumber: | 6304729502 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 AUDUBON WAY | ||||||||
| Address2: | |||||||||
| City: | LINCOLNSHIRE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600693811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478762200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2012 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | KROGER | ||||||||
| AuthorizedOfficialFirstName: | ELLIOT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6304728800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.