NPI 1104951698

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Organisation Physical Medicine & Rehabilitation Physician Chicago, IL

Practice location

Address: 5929 N Cicero Ave, Chicago, IL 60646-5701
Phone: (773) 529-4913
Mailing address: 293 Woodstone Cir, Buffalo Grove, IL 60089-6702

Authorised official

Name: Peter Smith
Title: Credentialing Agent
Phone: (815) 965-8505

Registered specialties

Physical Medicine & Rehabilitation Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208100000X Licence 036111300 (IL)

Other Physical Medicine & Rehabilitation providers in Illinois →

Registry record

NPI: 1104951698
Entity type: Organization
NPI issued: 23 Feb 2007
Record last updated: 7 Aug 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.