PALOS MEDICAL GROUP LLC. NPI 1255660312

NPI Information

NPI: 1255660312
Provider Name: PALOS MEDICAL GROUP, LLC.
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization

CLIA Number: 14D2047681

Address:
15300 WEST AVE
ORLAND PARK, IL
ZIP 60462
Phone: (708) 590-5304
Get Directions

PALOS MEDICAL GROUP, LLC. is an obstetrics gynecology in Orland Park, IL. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. PALOS MEDICAL GROUP, LLC. NPI is 1255660312. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

15300 WEST AVE
ORLAND PARK, IL
ZIP 60462-600
Phone: (708) 590-5304
Fax: (708) 590-5308

The provider's authorized official is Terrence C Moisan .
The authorized official title is President, Ceo and has the following contact phone number (708) 923-5000.

The CLIA number assigned to this NPI record is 14D2047681 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/18/2009 and was last updated on 1/26/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207V00000X	Obstetrics & Gynecology				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	36102101	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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