Healthcare Provider Details

I. General information

NPI: 1568122174
Provider Name (Legal Business Name): SOL MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7531 S STONY ISLAND AVE STE 164
CHICAGO IL
60649-3954
US

IV. Provider business mailing address

1201 S PRAIRIE AVE APT 4304
CHICAGO IL
60605-3552
US

V. Phone/Fax

Practice location:
  • Phone: 773-947-2831
  • Fax:
Mailing address:
  • Phone: 773-947-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEMBERLY BRIGGS
Title or Position: OWNER
Credential: MD
Phone: 850-251-8547