| Mpac Phc Of Il Pc | |
|
200 N La Salle St Ste 1550 Chicago IL 60601-1034 | |
| (888) 705-8722 | |
| Not Available |
| Full Name | Mpac Phc Of Il Pc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 200 N La Salle St Ste 1550, Chicago, Illinois |
| Authorized Official Name and Position | Timothy Martinez (CEO) |
| Authorized Official Contact | 8886604425 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mpac Phc Of Il Pc Po Box 5031 Pmb 17336 Evanston IL 60204-5031 Ph: (888) 705-8722 | Mpac Phc Of Il Pc 200 N La Salle St Ste 1550 Chicago IL 60601-1034 Ph: (888) 705-8722 |
| NPI Number | 1396402129 |
|---|---|
| Provider Enumeration Date | 11/29/2021 |
| Last Update Date | 12/10/2021 |
| Certification Date | 12/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396402129 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 363L00000X | Nurse Practitioner | (* (Not Available)) | Primary |
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