Provider Demographics
NPI:1487989216
Name:MEDPORTE, INC.
Entity type:Organization
Organization Name:MEDPORTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:AMARJIT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KULAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-457-9411
Mailing Address - Street 1:1821 WALDEN OFFICE SQ
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4295
Mailing Address - Country:US
Mailing Address - Phone:800-457-9411
Mailing Address - Fax:847-770-4973
Practice Address - Street 1:1821 WALDEN OFFICE SQ
Practice Address - Street 2:SUITE 400
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4295
Practice Address - Country:US
Practice Address - Phone:800-457-9411
Practice Address - Fax:847-770-4973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service