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1611 S Cicero Ave Cicero IL 60804-1520 | |
(708) 477-4840 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 1611 S Cicero Ave, Cicero, Illinois |
Authorized Official Name and Position | John E Vazquez (CMO) |
Authorized Official Contact | 7732573850 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3537 Paysphere Cir Chicago IL 60674-0035 Ph: (708) 786-2099 | 1611 S Cicero Ave Cicero IL 60804-1520 Ph: (708) 477-4840 |
NPI Number | 1194168377 |
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Provider Enumeration Date | 04/08/2013 |
Last Update Date | 04/08/2013 |
Identifier | Type | State | Issuer |
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1194168377 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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