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NPI Code Detail

MEDICARE: TELLEZ MEDICAL CENTER SC

MEDICARE: TELLEZ MEDICAL CENTER SC
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
1207Q00000XFamily Medicine PhysicianIL

General Provider Information

NPI Number : 1659324788
Entity Type Code : Organization
Provider Name (Legal Business Name) : TELLEZ MEDICAL CENTER SC
Provider Business Mailing Address
First Line : PO BOX 967
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-0967
Country : US
Telephone Number : 708-532-6029
Fax Number : 708-468-4991
Provider Business Practice Location Address
First Line : 9206 S COMMERCIAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4508
Country : US
Telephone Number : 773-978-0707
Fax Number :
Authorized Official
Title or Position : CEO
Name : JUAN L TELLEZ
Credential : MD
Telephone Number : 773-978-0707
Provider Enumeration Date : 05/18/2006
Last Update Date : 01/22/2019

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Directions to “TELLEZ MEDICAL CENTER SC ” Practice Location

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