Provider Demographics
NPI:1861137135
Name:PRIME HEALTH SYSTEM ,INC
Entity type:Organization
Organization Name:PRIME HEALTH SYSTEM ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAATOUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-730-7098
Mailing Address - Street 1:1030 N CLARK ST STE 647
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5469
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1030 N CLARK ST STE 647
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5469
Practice Address - Country:US
Practice Address - Phone:847-810-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086819OtherMEDICAL LICENSE