| Imed Glenview Llc | |
|
1247 Milwaukee Ave Glenview IL 60025-2464 | |
| (847) 962-3207 | |
| (847) 835-3058 |
| Full Name | Imed Glenview Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1247 Milwaukee Ave, Glenview, Illinois |
| Authorized Official Name and Position | Alexander Gorodetsky (CO-OWNER) |
| Authorized Official Contact | 8479623207 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imed Glenview Llc 1247 Milwaukee Ave Glenview IL 60025-2464 Ph: (847) 962-3207 | Imed Glenview Llc 1247 Milwaukee Ave Glenview IL 60025-2464 Ph: (847) 962-3207 |
| NPI Number | 1912199548 |
|---|---|
| Provider Enumeration Date | 08/16/2007 |
| Last Update Date | 08/16/2007 |
| Medicare PECOS PAC ID | 6800984477 |
|---|---|
| Medicare Enrollment ID | O20071115000015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912199548 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Illinois) | Primary |
| 2085R0202X | Radiology - Diagnostic Radiology | (Illinois) | Secondary |
| Provider Name | Alexander A Gorodetsky |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073541108 PECOS PAC ID: 0941281182 Enrollment ID: I20040525001079 |
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