Provider Demographics
NPI:1215528922
Name:TT MEDICAL GROUP LLC
Entity type:Organization
Organization Name:TT MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RUCHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-322-7149
Mailing Address - Street 1:741 S MCHENRY AVE STE C&D
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7445
Mailing Address - Country:US
Mailing Address - Phone:815-770-2780
Mailing Address - Fax:815-770-2780
Practice Address - Street 1:741 S MCHENRY AVE STE C&D
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7445
Practice Address - Country:US
Practice Address - Phone:815-770-2780
Practice Address - Fax:815-770-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty