| Primary Care Skokie | |
|
6315 N Milwaukee Ave # A Chicago IL 60646-3760 | |
| (847) 698-0661 | |
| (847) 768-9132 |
| Full Name | Primary Care Skokie |
|---|---|
| Speciality | Family Medicine |
| Location | 6315 N Milwaukee Ave # A, Chicago, Illinois |
| Authorized Official Name and Position | Amando A Reniva (PRESIDENT) |
| Authorized Official Contact | 8476980661 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Care Skokie 1125 S Washington Ave Park Ridge IL 60068-4814 Ph: (773) 551-3570 | Primary Care Skokie 6315 N Milwaukee Ave # A Chicago IL 60646-3760 Ph: (847) 698-0661 |
| NPI Number | 1639323942 |
|---|---|
| Provider Enumeration Date | 11/13/2008 |
| Last Update Date | 06/04/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639323942 | NPI | - | NPPES |
| 1639323942 | Other | NPI GROUP | |
| 207202 | Other | MEDICARE PTAN | |
| K01460 | Other | MEDICARE ID # | |
| 1932109352 | Other | IL | INDIVIDUAL NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036105799 (Illinois) | Primary |
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