| Crest Clinic Llc | |
|
2219 W Taylor St Chicago IL 60612-4424 | |
| (708) 323-7608 | |
| (708) 286-6461 |
| Full Name | Crest Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2219 W Taylor St, Chicago, Illinois |
| Authorized Official Name and Position | Obidike Augustine Nwakudu (PRESIDENT) |
| Authorized Official Contact | 7083237608 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crest Clinic Llc 2219 W Taylor St Chicago IL 60612-4424 Ph: (708) 323-7608 | Crest Clinic Llc 2219 W Taylor St Chicago IL 60612-4424 Ph: (708) 323-7608 |
| NPI Number | 1164750725 |
|---|---|
| Provider Enumeration Date | 11/19/2009 |
| Last Update Date | 11/26/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164750725 | NPI | - | NPPES |
| 036116618 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036116618 (Illinois) | Primary |
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