Healthcare Provider Details

I. General information

NPI: 1902900251
Provider Name (Legal Business Name): CAL-PARK HEALTH ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 W 127TH STREET
CALUMET PARK IL
60827-6129
US

IV. Provider business mailing address

1328 W 127TH STREET
CALUMET PARK IL
60827-6129
US

V. Phone/Fax

Practice location:
  • Phone: 708-389-3636
  • Fax: 708-389-8956
Mailing address:
  • Phone: 708-389-3636
  • Fax: 708-389-8956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. DORLENE WILLIAMS
Title or Position: OFFICE MANAGER
Credential: MA
Phone: 708-389-3636