| Theodore G James Mdsc | |
|
13000 Maple Ave Blue Island IL 60406-2318 | |
| (708) 799-8440 | |
| Not Available |
| Full Name | Theodore G James Mdsc |
|---|---|
| Speciality | Family Medicine |
| Location | 13000 Maple Ave, Blue Island, Illinois |
| Authorized Official Name and Position | Kim Wylie (OFFICE MANAGER) |
| Authorized Official Contact | 7087998440 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore G James Mdsc 18141 Dixie Hwy Ste 107 Homewood IL 60430-2241 Ph: () - | Theodore G James Mdsc 13000 Maple Ave Blue Island IL 60406-2318 Ph: (708) 799-8440 |
| NPI Number | 1962603837 |
|---|---|
| Provider Enumeration Date | 05/30/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0042308116 |
|---|---|
| Medicare Enrollment ID | O20071127000169 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962603837 | NPI | - | NPPES |
| 1626986 | Other | IL | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Illinois) | Primary |
| Provider Name | Theodore G James |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598741050 PECOS PAC ID: 6709873862 Enrollment ID: I20040429000711 |
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