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5533 W Cermak Rd Cicero IL 60804-2236 | |
(708) 780-7612 | |
(708) 780-9122 |
Full Name | |
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Speciality | Clinic/Center |
Location | 5533 W Cermak Rd, Cicero, Illinois |
Authorized Official Name and Position | Luis F Santiago (PRESIDENT) |
Authorized Official Contact | 7087807612 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 3666 Oak Park IL 60303-3666 Ph: (708) 780-7612 | 5533 W Cermak Rd Cicero IL 60804-2236 Ph: (708) 780-7612 |
NPI Number | 1154593051 |
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Provider Enumeration Date | 03/31/2008 |
Last Update Date | 03/31/2008 |
Medicare PECOS PAC ID | 0446312268 |
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Medicare Enrollment ID | O20090102000217 |
Identifier | Type | State | Issuer |
---|---|---|---|
1154593051 | NPI | - | NPPES |
01618077 | Other | IL | BLUE CROSS BLUE SHIELD |
L015046 | Other | IL | TRICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (Illinois) | Primary |
Provider Name | Luis F Santiago |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1871507236 PECOS PAC ID: 9739241555 Enrollment ID: I20090102000204 |
Roselia Herrera Md Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6039 W Cermak Rd, Cicero, IL 60804 Phone: 708-652-0056 | |
Mk Medical Group Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5729 W Cermak Rd, Cicero, IL 60804 Phone: 708-477-6525 | |
Hernan Reyes Md Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5610 W Cermak Rd, Unit #2, Cicero, IL 60804 Phone: 708-656-9247 Fax: 708-656-9358 | |