Provider Demographics
NPI:1285966440
Name:KOMPREHENSIVE PRIMARY CARE SPORTS & MUSCULOSKELETAL MEDICINE S.C.
Entity type:Organization
Organization Name:KOMPREHENSIVE PRIMARY CARE SPORTS & MUSCULOSKELETAL MEDICINE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-420-3445
Mailing Address - Street 1:845 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-2444
Mailing Address - Country:US
Mailing Address - Phone:312-420-3445
Mailing Address - Fax:773-536-3263
Practice Address - Street 1:2813 W 147TH ST
Practice Address - Street 2:
Practice Address - City:POSEN
Practice Address - State:IL
Practice Address - Zip Code:60469-1516
Practice Address - Country:US
Practice Address - Phone:708-396-9777
Practice Address - Fax:708-396-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114281207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty