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10074 W 190th Pl Ste 10074 Mokena IL 60448-8752 | |
| (630) 317-7690 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 10074 W 190th Pl Ste 10074, Mokena, Illinois |
| Authorized Official Name and Position | Amanda Wilkinson (BUSINESS OPERATIONS DIRECTOR) |
| Authorized Official Contact | 7028180446 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
10074 W 190th Pl Ste 10074 Mokena IL 60448-8752 Ph: () - | 10074 W 190th Pl Ste 10074 Mokena IL 60448-8752 Ph: (630) 317-7690 |
| NPI Number | 1194460154 |
|---|---|
| Provider Enumeration Date | 05/03/2022 |
| Last Update Date | 11/11/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194460154 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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