Provider Demographics
NPI:1104898121
Name:WEST DUNDEE PHYSICAL MEDICINE, S.C.
Entity type:Organization
Organization Name:WEST DUNDEE PHYSICAL MEDICINE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-222-9060
Mailing Address - Street 1:55 E EUCLID AVE STE 460
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1287
Mailing Address - Country:US
Mailing Address - Phone:847-222-9060
Mailing Address - Fax:847-222-9130
Practice Address - Street 1:650 SPRINGHILL RING RD
Practice Address - Street 2:#2005
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118
Practice Address - Country:US
Practice Address - Phone:847-844-7900
Practice Address - Fax:847-844-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4532199OtherBLUE CROSS