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150 W Half Day Rd Suite 105 Buffalo Grove IL 60089-6591 | |
| (847) 868-3435 | |
| (847) 859-5885 |
| Full Name | |
|---|---|
| Speciality | Physiological Laboratory |
| Location | 150 W Half Day Rd, Buffalo Grove, Illinois |
| Authorized Official Name and Position | Jack A Maggiore (DIRECTOR) |
| Authorized Official Contact | 8478683435 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
150 W Half Day Rd Suite 105 Buffalo Grove IL 60089-6591 Ph: (847) 868-3435 | 150 W Half Day Rd Suite 105 Buffalo Grove IL 60089-6591 Ph: (847) 868-3435 |
| NPI Number | 1881975266 |
|---|---|
| Provider Enumeration Date | 08/30/2011 |
| Last Update Date | 08/31/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881975266 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TH0100X | Psychologist - Health Service | (* (Not Available)) | Secondary |
| 293D00000X | Physiological Laboratory | (* (Not Available)) | Primary |
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