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1738 Washington St Waukegan IL 60085-5137 | |
| (847) 360-1019 | |
| (847) 360-6277 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 1738 Washington St, Waukegan, Illinois |
| Authorized Official Name and Position | Richard L Keller (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8473601019 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1738 Washington St Waukegan IL 60085-5137 Ph: (847) 360-1019 | 1738 Washington St Waukegan IL 60085-5137 Ph: (847) 360-1019 |
| NPI Number | 1407008998 |
|---|---|
| Provider Enumeration Date | 10/16/2008 |
| Last Update Date | 10/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407008998 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | A27740001A (Illinois) | Primary |
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