Provider Demographics
NPI:1144517830
Name:COMPLETE CARE MEDICAL CENTER, S.C
Entity type:Organization
Organization Name:COMPLETE CARE MEDICAL CENTER, S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ORAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKAVACHANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-650-1452
Mailing Address - Street 1:373 SUMMIT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60012
Mailing Address - Country:US
Mailing Address - Phone:847-888-3631
Mailing Address - Fax:847-888-3632
Practice Address - Street 1:373 SUMMIT ST STE 100
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120
Practice Address - Country:US
Practice Address - Phone:847-888-3631
Practice Address - Fax:847-888-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085859207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty