Provider Demographics
NPI:1861607285
Name:SANITAS MEDICAL GROUP SC
Entity type:Organization
Organization Name:SANITAS MEDICAL GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:PENAHERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-727-4292
Mailing Address - Street 1:1301 COPPERFIELD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-2056
Mailing Address - Country:US
Mailing Address - Phone:815-727-4292
Mailing Address - Fax:815-727-5395
Practice Address - Street 1:1301 COPPERFIELD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2056
Practice Address - Country:US
Practice Address - Phone:815-727-4292
Practice Address - Fax:815-727-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9928146OtherBC/BS
IL9928146OtherBC/BS