Healthcare Provider's Profile
Full Name | |
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Type | Facility |
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Speciality | Clinic/center - Multi-specialty |
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Location | 3245 Grove Ave Ste 205, Berwyn, Illinois |
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Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
NPI Data:
- NPI Number: 1932700770
- Provider Enumeration Date: 11/06/2020
- Last Update Date: 11/11/2024
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1932700770 | NPI | - | NPPES |
00 | Medicaid | IL | |
00 | Other | | PERSONAL INSURANCE |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
111NR0400X | Chiropractor - Rehabilitation | (* (Not Available)) | Secondary |
2081S0010X | Physical Medicine & Rehabilitation - Sports Medicine | (* (Not Available)) | Secondary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
3245 Grove Ave Ste 205, Berwyn, IL 60402-3476 Ph: (773) 947-4607 | 3245 Grove Ave Ste 205, Berwyn, IL 60402-3476 Ph: (773) 947-4607 |
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