Basic Information
| Provider Information | |||||||||
| NPI: | 1972070605 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIORCARE MEDICAL GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2160 COLCHESTER CT | ||||||||
| Address2: | |||||||||
| City: | HOFFMAN ESTATES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601924164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2243576997 | ||||||||
| FaxNumber: | 2242277312 | ||||||||
| Practice Location | |||||||||
| Address1: | 746 W SPRING ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601771424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476970565 | ||||||||
| FaxNumber: | 8476970568 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2018 | ||||||||
| LastUpdateDate: | 02/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | ONYIBOR | ||||||||
| AuthorizedOfficialFirstName: | KATE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2243576997 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.