Provider Demographics
NPI:1144270075
Name:ALLIANCE MEDICAL GROUP,S.C
Entity type:Organization
Organization Name:ALLIANCE MEDICAL GROUP,S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-955-1144
Mailing Address - Street 1:150 W HALF DAY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6591
Mailing Address - Country:US
Mailing Address - Phone:847-955-1144
Mailing Address - Fax:847-955-1166
Practice Address - Street 1:150 W HALF DAY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6591
Practice Address - Country:US
Practice Address - Phone:847-955-1144
Practice Address - Fax:847-955-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-109903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty