Organization · Type 2 NPI
Cook County
Primary Care Clinic/Center · Cicero, IL
NPI number
1104946904
Active
Practice location
2423 S Austin Blvd
Cicero, IL 60804-2616
Mailing address
1900 W Polk St Rm 220C
Chicago, IL 60612-3723
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Clinic/Center Primary | 261QP2300X | 0005272 (IL) |
Primary Care Clinic/Center: Definition to come...
4 other providers at this address
Other primary care clinic/center providers in Cicero
About NPI 1104946904
Cook County's National Provider Identifier is 1104946904, issued on Mar 29, 2007. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Cicero, IL. The record was last updated on Feb 22, 2019.