Provider Demographics
NPI:1174798318
Name:PREMIER HEALTH PARTNERS, LLC
Entity type:Organization
Organization Name:PREMIER HEALTH PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAFDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHSIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:224-622-5718
Mailing Address - Street 1:800 E WOODFIELD RD
Mailing Address - Street 2:STE 102
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4717
Mailing Address - Country:US
Mailing Address - Phone:847-995-9500
Mailing Address - Fax:847-995-9501
Practice Address - Street 1:800 E WOODFIELD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4717
Practice Address - Country:US
Practice Address - Phone:847-995-9500
Practice Address - Fax:847-995-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069581Medicaid
E24372Medicare UPIN
IL036069581Medicaid