Provider Demographics
NPI:1427599976
Name:ICZ MEDICAL GROUP
Entity type:Organization
Organization Name:ICZ MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIMGEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATUU
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:847-845-5998
Mailing Address - Street 1:5532 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE # B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1271
Mailing Address - Country:US
Mailing Address - Phone:847-845-5998
Mailing Address - Fax:224-404-4901
Practice Address - Street 1:5532 N MILWAUKEE AVE
Practice Address - Street 2:SUITE # B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1271
Practice Address - Country:US
Practice Address - Phone:847-845-5998
Practice Address - Fax:224-404-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203001895332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies