Provider Demographics
NPI:1194807370
Name:CORNERSTONE MEDICAL GROUP INC
Entity type:Organization
Organization Name:CORNERSTONE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURANDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-614-4000
Mailing Address - Street 1:2001 W WIESBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-7813
Mailing Address - Country:US
Mailing Address - Phone:630-614-4000
Mailing Address - Fax:630-614-4048
Practice Address - Street 1:2001 W WIESBROOK RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-7813
Practice Address - Country:US
Practice Address - Phone:630-614-4000
Practice Address - Fax:630-614-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCH3246OtherRR MEDICARE
ILCH3246OtherRR MEDICARE
ILCH3246OtherRR MEDICARE
IL=========6019001OtherHFS PAYEE ID