Provider Demographics
NPI:1730223009
Name:ENDEAVOR HEALTH MEDICAL GROUP
Entity type:Organization
Organization Name:ENDEAVOR HEALTH MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-570-5270
Mailing Address - Street 1:9811 WOODS DR
Mailing Address - Street 2:SUITE H180
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1074
Mailing Address - Country:US
Mailing Address - Phone:847-663-2100
Mailing Address - Fax:847-504-3121
Practice Address - Street 1:9811 WOODS DR
Practice Address - Street 2:SUITE H180
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1074
Practice Address - Country:US
Practice Address - Phone:847-663-2105
Practice Address - Fax:847-570-5040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL391800291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1620410OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL=========001Medicaid
IL=========OtherTAX ID NUMBER
IL1620410OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL391800Medicare ID - Type UnspecifiedCLINICAL PATHOLOGY
IL944352Medicare ID - Type UnspecifiedANATOMIC PATHOLOGY