| Presence Healthcare Services | |
|
5747 West Dempster Street Morton Grove IL 60053-3056 | |
| (708) 324-8700 | |
| (847) 324-8705 |
| Full Name | Presence Healthcare Services |
|---|---|
| Speciality | Internal Medicine |
| Location | 5747 West Dempster Street, Morton Grove, Illinois |
| Authorized Official Name and Position | Melvonne Wickliffe-jones (CREDENTIALING MGR) |
| Authorized Official Contact | 6309142417 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Presence Healthcare Services 1000 Remington Boulevard Bolingbrook IL 60440-0000 Ph: (630) 914-2417 | Presence Healthcare Services 5747 West Dempster Street Morton Grove IL 60053-3056 Ph: (708) 324-8700 |
| NPI Number | 1699078238 |
|---|---|
| Provider Enumeration Date | 12/20/2010 |
| Last Update Date | 04/10/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699078238 | NPI | - | NPPES |
| 036048363 | Medicaid | IL | |
| 036047645 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036047645 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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