The Center for Internal Medicine and Preventive Care S C

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036097015 Issued in IL

Legal business name

THE CENTER FOR INTERNAL MEDICINE AND PREVENTIVE CARE S C

Practice address

501 N Riverside Dr
Suite 216
Gurnee, IL 60031-5918

Phone

(847) 625-8300

Fax

(847) 625-8862

NPI assigned

Oct 2, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Paul TackNPI 1265446017

Title

President

Phone

(847) 814-2728

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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.

• Paul C Tack, M.D.

  • Internal Medicine Physician
  • Gurnee, IL
  • NPI 1265446017
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734739200000",
    "number": "1770770919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 N RIVERSIDE DR STE 216",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315918",
            "telephone_number": "847-625-8300",
            "fax_number": "847-625-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N RIVERSIDE DR",
            "address_2": "SUITE 216",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315918",
            "telephone_number": "847-625-8300",
            "fax_number": "847-625-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER FOR INTERNAL MEDICINE AND PREVENTIVE CARE S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2024-12-21",
        "certification_date": "2024-12-19",
        "status": "A",
        "authorized_official_last_name": "TACK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-814-2728",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036097015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marlene Juco Tanquilut, MD
• Walter Tatch
• Mark Taylor, PT
• Marson Tenoso, MD
• Nirguna Thalla, M.D.
• The Family Dentists LTD
• The Thresholds (Lake County)
• The Wright Advocate LLC
• Thera Ora PLLC
• Theresa's Home Care

• Internal Medicine Physician in Gurnee, IL
• Providers in Gurnee, 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 Dec 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.