Basic Information
| Provider Information | |||||||||
| NPI: | 1710902465 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEA MEDICAL CARE CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 4043 PO BOX 3594 | ||||||||
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| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605223594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308751500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1515 E LAKE ST | ||||||||
| Address2: | |||||||||
| City: | HANOVER PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601334896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474721500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | SULLIVAN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6304728800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.