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NPI Code Detail

MEDICARE: FENIX FAMILY HEALTH CENTER INC.

MEDICARE: FENIX FAMILY HEALTH CENTER INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center036082171IL
2207Q00000XFamily Medicine Physician336-044483

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11679788772OTHERILNPI

General Provider Information

NPI Number : 1124356431
Entity Type Code : Organization
Provider Name (Legal Business Name) : FENIX FAMILY HEALTH CENTER INC.
Provider Business Mailing Address
First Line : 130 WASHINGTON AVE
Second Line :
City : HIGHWOOD
State : IL
Zip : 60040-1122
Country : US
Telephone Number : 847-909-2004
Fax Number : 847-266-0961
Provider Business Practice Location Address
First Line : 130 WASHINGTON AVE
Second Line :
City : HIGHWOOD
State : IL
Zip : 60040-1122
Country : US
Telephone Number : 847-909-2004
Fax Number : 847-266-0961
Authorized Official
Title or Position : DIRECTOR
Name : DR. LOUISE BERNER-HOLMBERG
Credential : MD
Telephone Number : 847-909-2004
Provider Enumeration Date : 11/24/2009
Last Update Date : 04/05/2011

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