| Wilco Family Practice, Ltd. | |
|
2740 W Foster Ave Suite 307 Chicago IL 60625-3500 | |
| (872) 208-7709 | |
| (872) 208-7703 |
| Full Name | Wilco Family Practice, Ltd. |
|---|---|
| Speciality | Family Medicine |
| Location | 2740 W Foster Ave, Chicago, Illinois |
| Authorized Official Name and Position | Susan Wilcoski (PRESIDENT) |
| Authorized Official Contact | 8722087709 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilco Family Practice, Ltd. 5006 N Hamlin Ave Chicago IL 60625-6018 Ph: (773) 539-1983 | Wilco Family Practice, Ltd. 2740 W Foster Ave Suite 307 Chicago IL 60625-3500 Ph: (872) 208-7709 |
| NPI Number | 1134238934 |
|---|---|
| Provider Enumeration Date | 08/29/2006 |
| Last Update Date | 03/25/2014 |
| Medicare PECOS PAC ID | 8123156569 |
|---|---|
| Medicare Enrollment ID | O20100505001096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134238934 | NPI | - | NPPES |
| 036077561 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036077561 (Illinois) | Primary |
| Provider Name | Susan Wilcoski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902915796 PECOS PAC ID: 6305974742 Enrollment ID: I20100505001108 |
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