Provider Demographics
NPI:1265757835
Name:CALEEL MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:CALEEL MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SARKIS
Authorized Official - Last Name:CALEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-882-0070
Mailing Address - Street 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 216S
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:630-882-0070
Mailing Address - Fax:630-338-1201
Practice Address - Street 1:133 E BRUSH HILL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5659
Practice Address - Country:US
Practice Address - Phone:630-882-0070
Practice Address - Fax:630-338-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118890OtherLICENSE NUMBER
IL036118890OtherLICENSE NUMBER
ILIL3756Medicare PIN