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2423 S Austin Blvd Cicero IL 60804-2616 | |
| (708) 656-1130 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2423 S Austin Blvd, Cicero, Illinois |
| Authorized Official Name and Position | Scott Andrle (DIRECTOR OF MANAGED CARE OPERATIONS) |
| Authorized Official Contact | 3128644649 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1900 W Polk St Rm 220c Chicago IL 60612-3723 Ph: (312) 864-4649 | 2423 S Austin Blvd Cicero IL 60804-2616 Ph: (708) 656-1130 |
| NPI Number | 1104946904 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 02/22/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104946904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 0005272 (Illinois) | Primary |
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