Provider Demographics
NPI:1073015236
Name:CTCA PHYSICIANS GROUP OF ILLINOIS, INC
Entity type:Organization
Organization Name:CTCA PHYSICIANS GROUP OF ILLINOIS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NEETU
Authorized Official - Middle Name:
Authorized Official - Last Name:MASUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-342-6978
Mailing Address - Street 1:PO BOX 74008983
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 E ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5426
Practice Address - Country:US
Practice Address - Phone:847-746-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty