Provider Demographics
NPI:1124292560
Name:AAA-PRISM SCHAUMBURG LTD.
Entity type:Organization
Organization Name:AAA-PRISM SCHAUMBURG LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SATYADEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-539-9900
Mailing Address - Street 1:825 E SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3654
Mailing Address - Country:US
Mailing Address - Phone:630-539-9900
Mailing Address - Fax:630-539-9901
Practice Address - Street 1:825 E SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3654
Practice Address - Country:US
Practice Address - Phone:630-539-9900
Practice Address - Fax:630-539-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL'036112261Medicaid
IL1639119OtherBCBS OF IL
IL'036112261Medicaid
ILDN4906Medicare PIN
ILIL1084Medicare PIN