OrganizationActive
Prime Medical Clinic S.c.
NPI 1659815074 · Adult Medicine Physician · Glenview, IL
Provider details
- NPI number
- 1659815074
- Entity type
- Organization
- Primary specialty
- Adult Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Konstantins Kociasvili, Medical Doctor(773) 507-7434
- License
- 036135325 (IL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
3633 W Lake Ave Ste 307
Glenview, IL 60026-5803
Phone: (847) 626-8722
Fax: (847) 316-9502
Approximate (ZIP-level) locationGet directions
Mailing address
333 W Dundee Rd
Buffalo Grove, IL 60089-3545
Registry dates
- Enumerated
- 2016-12-05
- Last updated
- 2023-01-13
- Certified
- 2023-01-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.