Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2023-03-30
- Last updated
- 2023-03-30
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 2151 S WOLF RD
- City
- HILLSIDE IL
- Postal code
- 601622107
- Phone
- 708-562-6105
Organization contact
- Name
- KIRA TAYLOR
- Title
- manager
- Phone
- 2177092351
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.