Provider Demographics
NPI:1861078776
Name:PMG FOR SKILLED NURSING LLC
Entity type:Organization
Organization Name:PMG FOR SKILLED NURSING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZAFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-854-6540
Mailing Address - Street 1:1890 SILVER CROSS BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9603
Mailing Address - Country:US
Mailing Address - Phone:815-717-8737
Mailing Address - Fax:815-717-8699
Practice Address - Street 1:1890 SILVER CROSS BLVD STE 350
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9603
Practice Address - Country:US
Practice Address - Phone:815-717-8737
Practice Address - Fax:815-717-8699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZAFER JAWICH M.D. S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty