| Pai Participant 27, Pc | |
|
7050 S Madison St Willowbrook IL 60527-5548 | |
| (630) 323-6380 | |
| Not Available |
| Full Name | Pai Participant 27, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7050 S Madison St, Willowbrook, Illinois |
| Authorized Official Name and Position | Erin Laird (SR DIRECTOR/AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4104588713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pai Participant 27, Pc Po Box 639676 Cincinnati OH 45263-9676 Ph: (859) 291-4800 | Pai Participant 27, Pc 7050 S Madison St Willowbrook IL 60527-5548 Ph: (630) 323-6380 |
| NPI Number | 1093398539 |
|---|---|
| Provider Enumeration Date | 05/03/2021 |
| Last Update Date | 05/03/2021 |
| Medicare PECOS PAC ID | 2668872672 |
|---|---|
| Medicare Enrollment ID | O20210614001032 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093398539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Michelle Vandorn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093817355 PECOS PAC ID: 5597731273 Enrollment ID: I20040903000319 |
| Provider Name | Amy L Rohlfing |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1255335188 PECOS PAC ID: 3779511258 Enrollment ID: I20050727000618 |
| Provider Name | Katherine A Burnley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013397967 PECOS PAC ID: 0749598829 Enrollment ID: I20151009001910 |
| Provider Name | Marsha R Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154595072 PECOS PAC ID: 6305915943 Enrollment ID: I20160309000877 |
| Provider Name | Walter Lin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952481913 PECOS PAC ID: 9931425295 Enrollment ID: I20201205000160 |
| Provider Name | Mary E Maloney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710592175 PECOS PAC ID: 6608285234 Enrollment ID: I20210511001054 |
| Provider Name | Maria N Winsor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528593928 PECOS PAC ID: 7416224118 Enrollment ID: I20210712001269 |
Suriya Sastri, Mdpc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6900 S Madison St, Suite 102, Willowbrook, IL 60527 Phone: 630-325-8684 Fax: 630-325-2490 | |
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