| Komprehensive Primary Care Sports & Musculoskeletal Medicine S.c. | |
|
2813 W 147th St Posen IL 60469-1516 | |
| (708) 396-9777 | |
| (708) 396-9732 |
| Full Name | Komprehensive Primary Care Sports & Musculoskeletal Medicine S.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 2813 W 147th St, Posen, Illinois |
| Authorized Official Name and Position | Michael G Ward (PRESIDENT) |
| Authorized Official Contact | 3124203445 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Komprehensive Primary Care Sports & Musculoskeletal Medicine S.c. 845 E 40th St Chicago IL 60653-2444 Ph: (312) 420-3445 | Komprehensive Primary Care Sports & Musculoskeletal Medicine S.c. 2813 W 147th St Posen IL 60469-1516 Ph: (708) 396-9777 |
| NPI Number | 1285966440 |
|---|---|
| Provider Enumeration Date | 02/12/2010 |
| Last Update Date | 02/12/2010 |
| Medicare PECOS PAC ID | 2961699335 |
|---|---|
| Medicare Enrollment ID | O20101210000518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285966440 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 036114281 (Illinois) | Primary |
| Provider Name | Michael George Ward |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710953070 PECOS PAC ID: 9739194507 Enrollment ID: I20060215000418 |
| Provider Name | Shachi Pandya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164817334 PECOS PAC ID: 1951619709 Enrollment ID: I20191212001646 |
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