NPI 1164703823

Saint Anthony Pho, LLC

Organisation Health Maintenance Organization Chicago, IL

Practice location

Address: 2875 W 19th St, Chicago, IL 60623-3501
Phone: (773) 484-4015

Authorised official

Name: Aileen M Brooks
Title: Executive Committee Member
Phone: (773) 484-4015

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X

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Registry record

NPI: 1164703823
Entity type: Organization
NPI issued: 7 Sep 2011
Record last updated: 7 Sep 2011

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.