| College Of Applied Health Sciences Faculty Practice | |
|
1640 W Roosevelt Rd Room 336 (mc 628) Chicago IL 60608-1316 | |
| (312) 413-1567 | |
| (312) 413-1993 |
| Full Name | College Of Applied Health Sciences Faculty Practice |
|---|---|
| Speciality | Early Intervention Provider Agency |
| Location | 1640 W Roosevelt Rd, Chicago, Illinois |
| Authorized Official Name and Position | Bo L. Fernhall (DIRECTOR) |
| Authorized Official Contact | 3124131567 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| College Of Applied Health Sciences Faculty Practice 5254 Solution Center Chicago IL 60677-0001 Ph: (312) 413-1567 | College Of Applied Health Sciences Faculty Practice 1640 W Roosevelt Rd Room 336 (mc 628) Chicago IL 60608-1316 Ph: (312) 413-1567 |
| NPI Number | 1174554331 |
|---|---|
| Provider Enumeration Date | 07/06/2006 |
| Last Update Date | 01/20/2022 |
| Certification Date | 01/20/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174554331 | NPI | - | NPPES |
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