| Merrionette Park Physicians Group | |
|
9830 Ridgeland Ave Suite 7 Chicago Ridge IL 60415-2667 | |
| (708) 422-6800 | |
| (708) 422-6888 |
| Full Name | Merrionette Park Physicians Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 9830 Ridgeland Ave, Chicago Ridge, Illinois |
| Authorized Official Name and Position | Jerry R Coltro (PRESIDENT) |
| Authorized Official Contact | 7084226800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Merrionette Park Physicians Group 9830 Ridgeland Ave Suite 7 Chicago Ridge IL 60415-2667 Ph: (708) 422-6800 | Merrionette Park Physicians Group 9830 Ridgeland Ave Suite 7 Chicago Ridge IL 60415-2667 Ph: (708) 422-6800 |
| NPI Number | 1437186954 |
|---|---|
| Provider Enumeration Date | 06/28/2006 |
| Last Update Date | 01/03/2012 |
| Medicare PECOS PAC ID | 4082682794 |
|---|---|
| Medicare Enrollment ID | O20040921000518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437186954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 042617755 (* (Not Available)) | Primary |
| 207RR0500X | Internal Medicine - Rheumatology | 042617755 (Illinois) | Secondary |
| Provider Name | Raymond P Weiss |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528005634 PECOS PAC ID: 5597933945 Enrollment ID: I20110729000503 |
| Provider Name | Jerry R Coltro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962456442 PECOS PAC ID: 9234107947 Enrollment ID: I20120430000418 |
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