| Fullerton Kimball Medical Group Sc | |
|
3412 W Fullerton Ave Chicago IL 60647-2416 | |
| (773) 235-8000 | |
| Not Available |
| Full Name | Fullerton Kimball Medical Group Sc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 3412 W Fullerton Ave, Chicago, Illinois |
| Authorized Official Name and Position | Renlin Xia (PRESIDENT) |
| Authorized Official Contact | 7732358000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fullerton Kimball Medical Group Sc 3412 W Fullerton Ave Chicago IL 60647-2416 Ph: (773) 235-8000 | Fullerton Kimball Medical Group Sc 3412 W Fullerton Ave Chicago IL 60647-2416 Ph: (773) 235-8000 |
| NPI Number | 1831213081 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 08/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831213081 | NPI | - | NPPES |
| 01635426 | Other | IL | BCBS GROUP |
| 036088691 4 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (Illinois) | Primary |
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