| Sauganash Health Associates | |
|
2740 W. Foster Ave Suite 209 Chicago IL 60625-3599 | |
| (773) 293-3510 | |
| Not Available |
| Full Name | Sauganash Health Associates |
|---|---|
| Speciality | Family Medicine |
| Location | 2740 W. Foster Ave, Chicago, Illinois |
| Authorized Official Name and Position | Derek J Kelly (SENIOR PARTNER) |
| Authorized Official Contact | 7732933510 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sauganash Health Associates 2740 W Foster Ave Suite 209 Chicago IL 60625-3500 Ph: (773) 293-3510 | Sauganash Health Associates 2740 W. Foster Ave Suite 209 Chicago IL 60625-3599 Ph: (773) 293-3510 |
| NPI Number | 1487843496 |
|---|---|
| Provider Enumeration Date | 10/16/2007 |
| Last Update Date | 10/16/2007 |
| Medicare PECOS PAC ID | 6800052747 |
|---|---|
| Medicare Enrollment ID | O20120723000374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487843496 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Illinois) | Primary |
| 207R00000X | Internal Medicine | (Illinois) | Secondary |
| Provider Name | Derek J Kelly |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407989106 PECOS PAC ID: 9436062080 Enrollment ID: I20120723000409 |
| Provider Name | Maria E Rivera |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770616484 PECOS PAC ID: 2062678915 Enrollment ID: I20120723000499 |
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