| |
8012 S Crandon Ave, Chicago, IL 60617-1124 | |
(773) 356-5200 | |
(773) 768-8154 |
Full Name | |
---|---|
Type | Facility |
Speciality | Registered Nurse |
Location | 8012 S Crandon Ave, Chicago, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1225479470 | NPI | - | NPPES |
51204952001 | Medicaid | IL | |
214641 | Other | IL | AMERICAN ASSOCIATION OF DIABETES EDUCATORS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 164.004009 (Illinois) | Secondary |
163W00000X | Registered Nurse | 041.147476 (Illinois) | Primary |
Mailing Address | Practice Location Address |
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8012 S Crandon Ave, Chicago, IL 60617-1124 Ph: (773) 356-5200 | 8012 S Crandon Ave, Chicago, IL 60617-1124 Ph: (773) 356-5200 |