Graduated: 2016
NPI: 1467808089
Practice Locations (2)
PRIME HEALTHCARE ILLINOIS MEDICAL GROUP LLC
100 PROVENA WAY, SUITE 103
BOURBONNAIS, IL 609144797
8159378780
PRIME HEALTHCARE ILLINOIS MEDICAL GROUP LLC
501 S LOCUST ST
MANTENO, IL 609501654
8154686737
Source: CMS National Downloadable File, September 2026.