| Illinois | |
|
2655 Warrenville Rd Ste 500 Downers Grove IL 60515-5646 | |
| (657) 400-5180 | |
| Not Available |
| Full Name | Illinois |
|---|---|
| Speciality | General Practice |
| Location | 2655 Warrenville Rd Ste 500, Downers Grove, Illinois |
| Authorized Official Name and Position | Christopher Dennis (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 6572372450 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois 7755 Center Ave Ste 630 Huntington Beach CA 92647-9152 Ph: () - | Illinois 2655 Warrenville Rd Ste 500 Downers Grove IL 60515-5646 Ph: (657) 400-5180 |
| NPI Number | 1043934292 |
|---|---|
| Provider Enumeration Date | 09/30/2022 |
| Last Update Date | 01/30/2024 |
| Medicare PECOS PAC ID | 8527453851 |
|---|---|
| Medicare Enrollment ID | O20221205002343 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043934292 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Mohammad T Siddique |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1144439456 PECOS PAC ID: 9436225497 Enrollment ID: I20080828000094 |
| Provider Name | Brandy Eichelberger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750830451 PECOS PAC ID: 5698058634 Enrollment ID: I20170216002280 |
| Provider Name | Pamela Sullivan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326191107 PECOS PAC ID: 6305886011 Enrollment ID: I20221205002571 |
| Provider Name | Lena Jeanelle Gamble |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629312566 PECOS PAC ID: 5991082737 Enrollment ID: I20230428001546 |
| Provider Name | Julie Nguyen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477947380 PECOS PAC ID: 7214232107 Enrollment ID: I20230629001250 |
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