Provider Demographics
NPI:1437256708
Name:SAGE MEDICAL GROUP SC
Entity type:Organization
Organization Name:SAGE MEDICAL GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMNISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-549-7757
Mailing Address - Street 1:5425 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3404
Mailing Address - Country:US
Mailing Address - Phone:773-725-7557
Mailing Address - Fax:773-794-0138
Practice Address - Street 1:5425 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3404
Practice Address - Country:US
Practice Address - Phone:773-725-7557
Practice Address - Fax:773-794-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL356241Medicare PIN