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NPI 1245317536 Active Family Medicine

Quick Facts

NPI Number

1245317536

Type

Organization (NPI-2)

Status

Active

Enumeration Date

2006-11-01

Last Updated (NPPES)

2020-08-22

Primary Specialty / Taxonomy

Taxonomy	Family Medicine
Taxonomy Code	`207Q00000X`
License	036110045 IL

Practice Address

2222 W DIVISION ST
SUITE 260
CHICAGO, IL 606222717

Phone: 773-227-3770

Fax: 773-486-5224

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