| Commonwealth Medical Physician Group, S.c. | |
|
2800 N. Sheridan Rd #400 Chicago IL 60657-6157 | |
| (773) 472-5803 | |
| (773) 472-7902 |
| Full Name | Commonwealth Medical Physician Group, S.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2800 N. Sheridan Rd, Chicago, Illinois |
| Authorized Official Name and Position | Sharon Afable (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 7734725803 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Commonwealth Medical Physician Group, S.c. 2800 N. Sheridan Rd #400 Chicago IL 60657-6157 Ph: (773) 472-5803 | Commonwealth Medical Physician Group, S.c. 2800 N. Sheridan Rd #400 Chicago IL 60657-6157 Ph: (773) 472-5803 |
| NPI Number | 1194886754 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 09/14/2011 |
| Medicare PECOS PAC ID | 3476502998 |
|---|---|
| Medicare Enrollment ID | O20050121000350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194886754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036061003 (Illinois) | Primary |
| Provider Name | Donna W Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942262134 PECOS PAC ID: 2860474491 Enrollment ID: I20040607000271 |
| Provider Name | Alam Ali Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316946288 PECOS PAC ID: 9931174026 Enrollment ID: I20040901000297 |
| Provider Name | Bruce Avram Blacker |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982603924 PECOS PAC ID: 9537122783 Enrollment ID: I20041109000046 |
| Provider Name | Michael Todd Grendon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922007962 PECOS PAC ID: 1658320189 Enrollment ID: I20050121000383 |
| Provider Name | Owais W Lodhi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427212638 PECOS PAC ID: 1557420817 Enrollment ID: I20081101000141 |
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