| Trinity Health Provider Llc | |
|
4756 N Lamon Ave Chicago IL 60630-3840 | |
| (224) 518-8124 | |
| (888) 909-5815 |
| Full Name | Trinity Health Provider Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4756 N Lamon Ave, Chicago, Illinois |
| Authorized Official Name and Position | Renato M Cuervo (PRESIDENT) |
| Authorized Official Contact | 2245188124 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Health Provider Llc 7331 N Lincoln Ave Ste 15 Lincolnwood IL 60712-1766 Ph: (847) 983-8356 | Trinity Health Provider Llc 4756 N Lamon Ave Chicago IL 60630-3840 Ph: (224) 518-8124 |
| NPI Number | 1932763539 |
|---|---|
| Provider Enumeration Date | 04/29/2019 |
| Last Update Date | 04/29/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932763539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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