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3501 N Halsted St Chicago IL 60657-1832 | |
| (773) 388-1600 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Health Educator |
| Location | 3501 N Halsted St, Chicago, Illinois |
| Authorized Official Name and Position | Burgundy Johnson (BILLING MANAGER) |
| Authorized Official Contact | 7733883491 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4025 N Sheridan Chicago IL 60613 Ph: (773) 388-1600 | 3501 N Halsted St Chicago IL 60657-1832 Ph: (773) 388-1600 |
| NPI Number | 1881913531 |
|---|---|
| Provider Enumeration Date | 05/20/2010 |
| Last Update Date | 09/25/2024 |
| Medicare PECOS PAC ID | 1052203155 |
|---|---|
| Medicare Enrollment ID | O20091030000162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881913531 | NPI | - | NPPES |
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