| Biotidal Technology, Inc | |
|
3354 N Paulina St Suite 206c Chicago IL 60657-1068 | |
| (773) 991-5131 | |
| Not Available |
| Full Name | Biotidal Technology, Inc |
|---|---|
| Speciality | Clinic/center |
| Location | 3354 N Paulina St, Chicago, Illinois |
| Authorized Official Name and Position | Gregg S Horigan (PRESIDENT) |
| Authorized Official Contact | 7739915131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Biotidal Technology, Inc 4103 W Potomac Ave Chicago IL 60651-1853 Ph: (773) 486-9546 | Biotidal Technology, Inc 3354 N Paulina St Suite 206c Chicago IL 60657-1068 Ph: (773) 991-5131 |
| NPI Number | 1710145933 |
|---|---|
| Provider Enumeration Date | 05/23/2008 |
| Last Update Date | 05/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710145933 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 038-006984 (Illinois) | Primary |
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