| Southside Primary Care Group Sc | |
|
7531 S Stony Island Ave Suite 164 Chicago IL 60649-3954 | |
| (773) 947-2831 | |
| Not Available |
| Full Name | Southside Primary Care Group Sc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7531 S Stony Island Ave, Chicago, Illinois |
| Authorized Official Name and Position | Syed Najeeb (M.D.) |
| Authorized Official Contact | 7739472831 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Primary Care Group Sc 1720 S Michigan Ave Apt 2909 Chicago IL 60616-4861 Ph: (773) 947-2831 | Southside Primary Care Group Sc 7531 S Stony Island Ave Suite 164 Chicago IL 60649-3954 Ph: (773) 947-2831 |
| NPI Number | 1417403072 |
|---|---|
| Provider Enumeration Date | 09/01/2016 |
| Last Update Date | 02/07/2024 |
| Medicare PECOS PAC ID | 4587952650 |
|---|---|
| Medicare Enrollment ID | O20161006000067 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417403072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036111469 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | 036111469 (Illinois) | Primary |
| Provider Name | Syed Najeeb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134275928 PECOS PAC ID: 6305884339 Enrollment ID: I20050420001036 |
| Provider Name | Marquita Denise Porche |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326723578 PECOS PAC ID: 3274994215 Enrollment ID: I20230807002514 |
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