Family Health and Fitness Specialists, LTD.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036105926 Issued in IL

Legal business name

FAMILY HEALTH AND FITNESS SPECIALISTS, LTD.

Practice address

455 Briargate Dr
South Elgin, IL 60177-2225

Phone

(847) 622-0506

Fax

(847) 622-0507

NPI assigned

Aug 12, 2006

Organization subpart

No

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

Authorized official

Name

Matthew Brandon

Title

President

Phone

(847) 622-0506

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373414400000",
    "number": "1790797686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 BRIARGATE DR",
            "city": "SOUTH ELGIN",
            "state": "IL",
            "postal_code": "601772225",
            "telephone_number": "847-622-0506",
            "fax_number": "847-622-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 BRIARGATE DR",
            "city": "SOUTH ELGIN",
            "state": "IL",
            "postal_code": "601772225",
            "telephone_number": "847-622-0506",
            "fax_number": "847-622-0507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH AND FITNESS SPECIALISTS, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2013-07-10",
        "status": "A",
        "authorized_official_last_name": "BRANDON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-622-0506"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036105926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036105926 3",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4532366",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in South Elgin, IL
• Providers in South Elgin, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.