NPIMap

Organization Active NPI

Epmg of Illinois LLC

  • Emergency Medicine Physician
  • Kankakee, IL
National Provider Identifier
1528098902
Registry record updated Jul 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
EPMG OF ILLINOIS LLC
Practice address
350 N Wall St
Kankakee, IL 60901-2901
Phone
(469) 401-2386
NPI assigned
Jul 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2020

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

Authorized official

Name
Dr. Mike Mikhail, M.D.
Title
Officer
Phone
(973) 251-1132

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

350 N Wall St
Kankakee, IL 60901-2901

Mailing address

5565 Centerview Dr Ste 107
Raleigh, NC 27606-3563
Phone (973) 251-1132

Other identifiers 1

IdentifierTypeStateIssuer
07223735OtherILBC/BS OF ILLINOIS

National Provider Directory

National Provider Directory

Locations

Use Ch3081
Peoria, IL 61636

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596153600000",
    "number": "1528098902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 CENTERVIEW DR STE 107",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276063563",
            "telephone_number": "973-251-1132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012901",
            "telephone_number": "469-401-2386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPMG OF ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A",
        "authorized_official_last_name": "MIKHAIL",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "973-251-1132",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF ILLINOIS",
            "identifier": "07223735",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kankakee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; 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.