| Lifemine Health, Llc | |
|
6847 Kingery Hwy Willowbrook IL 60527-5114 | |
| (630) 655-9555 | |
| (630) 655-9595 |
| Full Name | Lifemine Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6847 Kingery Hwy, Willowbrook, Illinois |
| Authorized Official Name and Position | Anthony W. Delorenzo (OWNER) |
| Authorized Official Contact | 6306559555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifemine Health, Llc 6847 Kingery Hwy Willowbrook IL 60527-5114 Ph: (630) 655-9555 | Lifemine Health, Llc 6847 Kingery Hwy Willowbrook IL 60527-5114 Ph: (630) 655-9555 |
| NPI Number | 1740461664 |
|---|---|
| Provider Enumeration Date | 11/20/2007 |
| Last Update Date | 08/24/2020 |
| Medicare PECOS PAC ID | 7214017003 |
|---|---|
| Medicare Enrollment ID | O20080107000303 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740461664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036089038 (Illinois) | Primary |
| Provider Name | Anthony W Delorenzo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851477236 PECOS PAC ID: 1052415361 Enrollment ID: I20070327000139 |
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