Organization · Type 2 NPI

Mamanatandathernizampc.

Community Health Clinic/Center · Chicago, IL

NPI number 1104134915 Active

Practice location

2001 W.69THST.
Chicago, IL 60636

Call (773) 778-2355 Map

Fax (773) 788-2355

Mailing address

401 Tamerton Pkwy
Burr Ridge, IL 60527-6347

Specialties and licenses

TaxonomyCodeLicense
Community Health Clinic/Center Primary 261QC1500X000000000 (IL)

Community Health Clinic/Center: Definition to come...

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About NPI 1104134915

Mamanatandathernizampc.'s National Provider Identifier is 1104134915, issued on Sep 15, 2010. The primary taxonomy on file is Community Health Clinic/Center (261QC1500X), and the practice location is in Chicago, IL. The record was last updated on Nov 2, 2026.