| Center Street Medical | |
|
103 N Haven Rd Fl 2 Elmhurst IL 60126-2973 | |
| (630) 595-9988 | |
| (331) 225-2296 |
| Full Name | Center Street Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 103 N Haven Rd Fl 2, Elmhurst, Illinois |
| Authorized Official Name and Position | Margaret Hornstra (OFFICE MANAGER) |
| Authorized Official Contact | 6305959988 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center Street Medical 103 N Haven Rd Fl 2 Elmhurst IL 60126-2973 Ph: (630) 595-9988 | Center Street Medical 103 N Haven Rd Fl 2 Elmhurst IL 60126-2973 Ph: (630) 595-9988 |
| NPI Number | 1114119245 |
|---|---|
| Provider Enumeration Date | 08/13/2007 |
| Last Update Date | 09/24/2018 |
| Medicare PECOS PAC ID | 2567436330 |
|---|---|
| Medicare Enrollment ID | O20040826000045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114119245 | NPI | - | NPPES |
| 036082085 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036082085 (Illinois) | Primary |
| Provider Name | Paul M Baubly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174681530 PECOS PAC ID: 4183698954 Enrollment ID: I20040827000020 |
| Provider Name | Marsha Cyndi Cansler |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1396142691 PECOS PAC ID: 1456674449 Enrollment ID: I20141223002339 |
| Provider Name | Kathryn A Baubly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295129310 PECOS PAC ID: 7012212798 Enrollment ID: I20180614000731 |
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