| Presence Medical Group | |
|
112 S Northwest Hwy Park Ridge IL 60068-4260 | |
| (847) 696-3370 | |
| (847) 692-3884 |
| Full Name | Presence Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 112 S Northwest Hwy, Park Ridge, 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 Medical Group 1000 Remington Boulevard Bolingbrook IL 60440-0000 Ph: (630) 914-2417 | Presence Medical Group 112 S Northwest Hwy Park Ridge IL 60068-4260 Ph: (847) 696-3370 |
| NPI Number | 1518074608 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 04/10/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518074608 | NPI | - | NPPES |
| 036121820 | Medicaid | IL | |
| 036108128 | Other | IL | MEDICAID |
| 036119065 | Medicaid | IL | |
| 036087005 | Medicaid | IL | |
| 036080241 | Medicaid | IL | |
| 036121594 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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