Provider Demographics
NPI:1144311515
Name:PB SALES MD RM SALES MD & ASSOCIATES SC
Entity type:Organization
Organization Name:PB SALES MD RM SALES MD & ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PASCUAL
Authorized Official - Middle Name:BAQUIRAN
Authorized Official - Last Name:SALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-821-7515
Mailing Address - Street 1:11101 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4206
Mailing Address - Country:US
Mailing Address - Phone:773-821-7515
Mailing Address - Fax:773-821-6970
Practice Address - Street 1:11101 S STATE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4206
Practice Address - Country:US
Practice Address - Phone:773-821-7515
Practice Address - Fax:773-821-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
328470Medicare ID - Type Unspecified