| Prairie Glen Primary Care, P.c. | |
|
15505 127th St Lemont IL 60439-4433 | |
| (630) 257-5400 | |
| (630) 257-1954 |
| Full Name | Prairie Glen Primary Care, P.c. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 15505 127th St, Lemont, Illinois |
| Authorized Official Name and Position | Ilah Marie Heller-bair (OWNER) |
| Authorized Official Contact | 6302575400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Glen Primary Care, P.c. 15505 127th St Lemont IL 60439-4433 Ph: (630) 257-5400 | Prairie Glen Primary Care, P.c. 15505 127th St Lemont IL 60439-4433 Ph: (630) 257-5400 |
| NPI Number | 1851458699 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 09/27/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851458699 | NPI | - | NPPES |
| 6599328 | Other | IL | CIGNA |
| 01634883 | Other | IL | BLUE CROSS BLUE SHIELD O |
| 036110756 | Medicaid | IL | |
| 276 | Other | IL | SILVER CROSS MANAGED CARE |
| 5936374 | Other | IL | AETNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036110756 (Illinois) | Primary |
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