Medintel PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

036114198 Issued in IL

Legal business name

MEDINTEL PC

Practice address

532 Lockard LN
Highwood, IL 60040-1223

Phone

(773) 750-9696

Fax

(224) 848-6296

NPI assigned

Jul 7, 2014

Last updated

Jul 7, 2014By 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

Nelly Kvirikadze, MD

Title

President

Phone

(773) 750-9696

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404691200000",
    "number": "1922414358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "532 LOCKARD LN",
            "city": "HIGHWOOD",
            "state": "IL",
            "postal_code": "600401223",
            "telephone_number": "773-750-9696",
            "fax_number": "224-848-6296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "532 LOCKARD LN",
            "city": "HIGHWOOD",
            "state": "IL",
            "postal_code": "600401223",
            "telephone_number": "773-750-9696",
            "fax_number": "224-848-6296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDINTEL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-07",
        "last_updated": "2014-07-07",
        "status": "A",
        "authorized_official_last_name": "KVIRIKADZE",
        "authorized_official_first_name": "NELLY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-750-9696",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "036114198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036114198",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamella Lee Leiter, OTR
• Kaja Lundevall, RN
• Michelle Mary Marrocco, LPC
• Mason T. Hoel, DC, PC
• Leslie Ann McGregor
• Margarita Mendoza
• Diana Meraz, CCC-SLP
• Lois Moss-Barnwell, MS, RD, LDN, CDE
• Movement Possibilities
• Wesley A Murphy, MS, RDN, LDN

• Primary Care Clinic/Center in Highwood, IL
• Providers in Highwood, IL by specialty
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2014; 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.