| Miinedoctor, Inc. | |
|
13755 Cicero Ave Crestwood IL 60418-1824 | |
| (708) 972-7642 | |
| (708) 925-9179 |
| Full Name | Miinedoctor, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 13755 Cicero Ave, Crestwood, Illinois |
| Authorized Official Name and Position | Ashley Rock (DIRECTOR OF CLINICAL OPERATIONS) |
| Authorized Official Contact | 7089727636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miinedoctor, Inc. 13755 Cicero Ave Crestwood IL 60418-1824 Ph: (708) 972-7636 | Miinedoctor, Inc. 13755 Cicero Ave Crestwood IL 60418-1824 Ph: (708) 972-7642 |
| NPI Number | 1144795279 |
|---|---|
| Provider Enumeration Date | 10/04/2018 |
| Last Update Date | 12/17/2021 |
| Medicare PECOS PAC ID | 7012259252 |
|---|---|
| Medicare Enrollment ID | O20190508001875 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144795279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Zafar Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700872272 PECOS PAC ID: 3577606524 Enrollment ID: I20100130000023 |
| Provider Name | Daniel C Desimone |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447246822 PECOS PAC ID: 4385787332 Enrollment ID: I20100130000038 |
| Provider Name | Luciano Fochesatto Filho |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356591549 PECOS PAC ID: 6406042522 Enrollment ID: I20101201000027 |
| Provider Name | Maged A Saad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154634145 PECOS PAC ID: 8921262098 Enrollment ID: I20120621000360 |
| Provider Name | Muhammad B Abushaer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942258983 PECOS PAC ID: 8022053495 Enrollment ID: I20130227000463 |
| Provider Name | Earl Hamilton Rudolph |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487851481 PECOS PAC ID: 2466641618 Enrollment ID: I20150113002515 |
| Provider Name | Jacqueline L Marchbank |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750767604 PECOS PAC ID: 6002116316 Enrollment ID: I20151118000708 |
| Provider Name | Kristine Joyce Langcauon Asuncion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306332697 PECOS PAC ID: 9436406014 Enrollment ID: I20180728000162 |
| Provider Name | Christopher Michael Gloude |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992286868 PECOS PAC ID: 7214273655 Enrollment ID: I20190107001517 |
| Provider Name | John Fikry Mityas Ibrahim |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134675218 PECOS PAC ID: 2264761055 Enrollment ID: I20190903003080 |
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Metro Infectious Disease Consultants Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 13755 S. Cicero Ave, Crestwood, IL 60445 Phone: 708-972-7642 Fax: 708-925-9179 | |
Trio Health Medical Il Np Partners Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14255 Cicero Ave, Crestwood, IL 60418 Phone: 708-371-0400 Fax: 708-371-0610 | |
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