Provider Demographics
NPI:1134247984
Name:CENTER FOR PHYSICAL HEALTH LTD
Entity type:Organization
Organization Name:CENTER FOR PHYSICAL HEALTH LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-301-8585
Mailing Address - Street 1:2201 W SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3891
Mailing Address - Country:US
Mailing Address - Phone:847-301-8585
Mailing Address - Fax:847-301-8582
Practice Address - Street 1:2201 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3891
Practice Address - Country:US
Practice Address - Phone:847-301-8585
Practice Address - Fax:847-301-8582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006247261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL380390Medicare ID - Type UnspecifiedMEDICARE