| Loyola University Physician Foundation | |
|
2160 S 1st Ave Maywood IL 60153-3328 | |
| (800) 424-6307 | |
| Not Available |
| Full Name | Loyola University Physician Foundation |
|---|---|
| Speciality | General Practice |
| Location | 2160 S 1st Ave, Maywood, Illinois |
| Authorized Official Name and Position | Peter Gouws (VICE PRESIDENT AND CFO) |
| Authorized Official Contact | 7082163981 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Loyola University Physician Foundation 2 Westbrook Corporate Ctr S#600 Westchester IL 60154-5702 Ph: (800) 424-6307 | Loyola University Physician Foundation 2160 S 1st Ave Maywood IL 60153-3328 Ph: (800) 424-6307 |
| NPI Number | 1235148891 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 09/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235148891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (Illinois) | Primary |
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