| Norridge Family Practice | |
|
7830 W Lawrence Ave Norridge IL 60706-3267 | |
| (708) 457-8083 | |
| (708) 457-8172 |
| Full Name | Norridge Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 7830 W Lawrence Ave, Norridge, Illinois |
| Authorized Official Name and Position | Leonard Dedic (VICE PRESIDENT) |
| Authorized Official Contact | 7085836818 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Norridge Family Practice 7830 W Lawrence Ave Norridge IL 60706-3267 Ph: (708) 457-8083 | Norridge Family Practice 7830 W Lawrence Ave Norridge IL 60706-3267 Ph: (708) 457-8083 |
| NPI Number | 1578769212 |
|---|---|
| Provider Enumeration Date | 06/21/2007 |
| Last Update Date | 07/22/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578769212 | NPI | - | NPPES |
| 036121820 | Medicaid | IL | |
| 01637820 | Other | IL | BLUE CROSS BLUE SHIELD GROUP |
| 036119065 | Other | IL | STATE LICENSURE |
| 036121594 | Other | IL | STATE LICENSURE |
| 215846 | Other | IL | MEDICARE GROUP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036108044 (Illinois) | Primary |
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