Provider Demographics
NPI:1396950002
Name:QUALITY LIFE PHYSICIAN CARE, S.C.
Entity type:Organization
Organization Name:QUALITY LIFE PHYSICIAN CARE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHLAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-371-9325
Mailing Address - Street 1:7933 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3632
Mailing Address - Country:US
Mailing Address - Phone:847-933-1199
Mailing Address - Fax:847-933-0099
Practice Address - Street 1:7933 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3632
Practice Address - Country:US
Practice Address - Phone:847-933-1199
Practice Address - Fax:847-933-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK29139Medicare PIN