Provider Demographics
NPI:1871705368
Name:PLATINUM FAMILY MEDICINE SC.
Entity type:Organization
Organization Name:PLATINUM FAMILY MEDICINE SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-689-4944
Mailing Address - Street 1:1012 95TH ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5041
Mailing Address - Country:US
Mailing Address - Phone:630-689-4944
Mailing Address - Fax:630-717-0981
Practice Address - Street 1:1012 95TH ST
Practice Address - Street 2:SUITE 9
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5041
Practice Address - Country:US
Practice Address - Phone:630-689-4944
Practice Address - Fax:630-717-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619030207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2233203OtherBCBS PROVIDER ID
IL042619030OtherMED CORP REGISTRATION
ILDG5143OtherRAILROAD MEDICARE
IL042619030OtherMED CORP REGISTRATION
ILDG5143OtherRAILROAD MEDICARE