Provider Demographics
NPI:1144347352
Name:MEADOWS MEDICAL GROUP, LTD
Entity type:Organization
Organization Name:MEADOWS MEDICAL GROUP, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANIQUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-231-6026
Mailing Address - Street 1:1170 E BELVIDERE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2034
Mailing Address - Country:US
Mailing Address - Phone:847-231-6026
Mailing Address - Fax:847-231-6029
Practice Address - Street 1:1170 E BELVIDERE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2034
Practice Address - Country:US
Practice Address - Phone:847-231-6026
Practice Address - Fax:847-231-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042618432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4932372OtherBLUE CROSS BLUE SHIELD
IL4932372OtherBLUE CROSS BLUE SHIELD