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12200 Western Ave Blue Island IL 60406-1398 | |
| (630) 581-5372 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 12200 Western Ave, Blue Island, Illinois |
| Authorized Official Name and Position | Judith Scott (BILLING MANGER) |
| Authorized Official Contact | 6305815372 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12200 Western Ave Blue Island IL 60406-1398 Ph: (630) 581-5372 | 12200 Western Ave Blue Island IL 60406-1398 Ph: (630) 581-5372 |
| NPI Number | 1063954220 |
|---|---|
| Provider Enumeration Date | 11/04/2016 |
| Last Update Date | 11/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063954220 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036090435 (* (Not Available)) | Primary |
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