| Private Practice Of River Forest | |
|
675 W North Ave Suite 202 Melrose Park IL 60160-1634 | |
| (708) 681-7905 | |
| (708) 460-1117 |
| Full Name | Private Practice Of River Forest |
|---|---|
| Speciality | Internal Medicine |
| Location | 675 W North Ave, Melrose Park, Illinois |
| Authorized Official Name and Position | Charles B Johnston (PRESIDENT) |
| Authorized Official Contact | 7086817905 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Private Practice Of River Forest Po Box 379 Orland Park IL 60462-0379 Ph: (708) 460-9833 | Private Practice Of River Forest 675 W North Ave Suite 202 Melrose Park IL 60160-1634 Ph: (708) 681-7905 |
| NPI Number | 1407000177 |
|---|---|
| Provider Enumeration Date | 11/07/2008 |
| Last Update Date | 11/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407000177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036078749 (Illinois) | Primary |
| 208000000X | Pediatrics | 036078749 (Illinois) | Secondary |
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