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2423 S Austin Blvd Cicero IL 60804-2616 | |
(708) 656-1130 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 2423 S Austin Blvd, Cicero, Illinois |
Authorized Official Name and Position | Scott Andrle (DIRECTOR OF MANAGED CARE OPERATIONS) |
Authorized Official Contact | 3128644649 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1900 W Polk St Rm 220c Chicago IL 60612-3723 Ph: () - | 2423 S Austin Blvd Cicero IL 60804-2616 Ph: (708) 656-1130 |
NPI Number | 1457982449 |
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Provider Enumeration Date | 01/29/2020 |
Last Update Date | 03/02/2020 |
Identifier | Type | State | Issuer |
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1457982449 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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