| Siloam Home And Wound Care Physicians Inc | |
|
1342 W Grenshaw St Apt 1 Chicago IL 60607-0025 | |
| (312) 590-1601 | |
| (312) 626-2161 |
| Full Name | Siloam Home And Wound Care Physicians Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1342 W Grenshaw St Apt 1, Chicago, Illinois |
| Authorized Official Name and Position | Joseph Ofisi (PRESIDENT) |
| Authorized Official Contact | 3125901601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Siloam Home And Wound Care Physicians Inc 908 S Laflin St Chicago IL 60607-4024 Ph: (312) 590-1601 | Siloam Home And Wound Care Physicians Inc 1342 W Grenshaw St Apt 1 Chicago IL 60607-0025 Ph: (312) 590-1601 |
| NPI Number | 1861814915 |
|---|---|
| Provider Enumeration Date | 01/08/2014 |
| Last Update Date | 07/08/2024 |
| Medicare PECOS PAC ID | 6709015324 |
|---|---|
| Medicare Enrollment ID | O20140131000259 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861814915 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Robert S Glick |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1982742920 PECOS PAC ID: 8224934336 Enrollment ID: I20031210000112 |
| Provider Name | Cherechi V Onyenso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578855219 PECOS PAC ID: 5193977114 Enrollment ID: I20121219000573 |
| Provider Name | Joseph W Ofisi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295057610 PECOS PAC ID: 3375797830 Enrollment ID: I20130208000269 |
| Provider Name | Tyra Bernice Franklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295106268 PECOS PAC ID: 6901107895 Enrollment ID: I20151218000233 |
| Provider Name | Ernesto Agron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124277975 PECOS PAC ID: 0648524504 Enrollment ID: I20181112001542 |
| Provider Name | Tracey M Ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134774771 PECOS PAC ID: 4183953979 Enrollment ID: I20190903003051 |
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