Provider Demographics
NPI:1780706481
Name:PERSONALIZED PHYSICIANS GROUP LTD
Entity type:Organization
Organization Name:PERSONALIZED PHYSICIANS GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLBABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-580-7600
Mailing Address - Street 1:7 BLANCHARD CIR
Mailing Address - Street 2:STE. 106
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-1037
Mailing Address - Country:US
Mailing Address - Phone:630-580-7600
Mailing Address - Fax:630-580-7624
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:STE. 106
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-1037
Practice Address - Country:US
Practice Address - Phone:630-580-7600
Practice Address - Fax:630-580-7624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215362Medicare PIN