Kimball Medical Center SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

KIMBALL MEDICAL CENTER SC

Practice address

2837 N Milwaukee Ave
Chicago, IL 60618-7403

Phone

(773) 235-6266

NPI assigned

Jun 3, 2006

Last updated

Jul 26, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ely Robert TandeterNPI 1457306953

Title

Owner

Phone

(773) 235-6266

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ely Robert Tandeter

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1457306953
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374796800000",
    "number": "1245278233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2837 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606187403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2837 N MILWAUKEE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606187403",
            "telephone_number": "773-235-6266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBALL MEDICAL CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2013-07-26",
        "status": "A",
        "authorized_official_last_name": "TANDETER",
        "authorized_official_first_name": "ELY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-235-6266"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Young Jae Kim, MD
• Yunji Kim
• Yurie Kim
• Zin Young Kim
• Kimball Ladien,MD
• Charles Kimball
• John Kimball
• Kimberly M Egly LTD (gold coast chiropractic)
• Kimberly Mathis-Harris (The Eye Bar optics)
• Kimberly Smiles

• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.