Evergreen Medical Group SC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036090073 Issued in IL

Legal business name

EVERGREEN MEDICAL GROUP SC

Practice address

2000 McDonald Rd
Suite 220
South Elgin, IL 60177-3323

Phone

(847) 468-1206

Fax

(847) 468-1507

NPI assigned

May 31, 2007

Organization subpart

No

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

Authorized official

Name

Michelle M Seo, MD

Title

Director

Phone

(847) 468-1206

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266451200000",
    "number": "1396946695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1509",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601211509",
            "telephone_number": "224-238-4160",
            "fax_number": "847-214-9489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 MCDONALD RD",
            "address_2": "SUITE 220",
            "city": "SOUTH ELGIN",
            "state": "IL",
            "postal_code": "601773323",
            "telephone_number": "847-468-1206",
            "fax_number": "847-468-1507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MEDICAL GROUP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2010-02-18",
        "status": "A",
        "authorized_official_last_name": "SEO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "847-468-1206",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036090073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0004532435",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in South Elgin, IL
• Providers in South Elgin, 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 Feb 18, 2010; 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.