Provider Demographics
NPI:1871530436
Name:INTERNAL MEDICINE ASSOCIATES OF KANKAKEE, LTD
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF KANKAKEE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-933-0007
Mailing Address - Street 1:400 S KENNEDY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2682
Mailing Address - Country:US
Mailing Address - Phone:815-933-0007
Mailing Address - Fax:815-933-2776
Practice Address - Street 1:400 S KENNEDY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BRADLEY
Practice Address - State:IL
Practice Address - Zip Code:60915-2682
Practice Address - Country:US
Practice Address - Phone:815-933-0007
Practice Address - Fax:815-933-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL174184OtherFEDERAL BLACK LUNG
IL4600191OtherBUE CROSS/BLUE SHIELD
IL5043293OtherAETNA
ILD86546Medicare UPIN
IL4600191OtherBUE CROSS/BLUE SHIELD