Provider Demographics
NPI:1447291547
Name:MONROE MEDICAL ASSOCIATES, SC
Entity type:Organization
Organization Name:MONROE MEDICAL ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOZLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-339-4800
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-836-2860
Mailing Address - Fax:
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-339-4800
Practice Address - Fax:708-339-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042003867207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN105630OtherANTHEM B S GRP PROV #
IL042003867OtherIL REG MED CORP #
IL1615180OtherB C B S GROUP PROV #
IN100394430Medicaid
IN626820Medicare ID - Type UnspecifiedMCARE GROUP PROV #
IL1615180OtherB C B S GROUP PROV #
IN100394430Medicaid
IL437901Medicare ID - Type UnspecifiedMCARE GROUP PROV #
IL4269010001Medicare NSC