Healthcare Provider Details

I. General information

NPI: 1285741033
Provider Name (Legal Business Name): PRESENCE HEALTHCARE SERVICES PRESENCE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 N MILWAUKEE AVE
CHICAGO IL
60630-2145
US

IV. Provider business mailing address

1000 REMINGTON BOULEVARD
BOLINGBROOK IL
60440-0000
US

V. Phone/Fax

Practice location:
  • Phone: 773-205-2857
  • Fax: 708-205-4380
Mailing address:
  • Phone: 630-914-2417
  • Fax: 630-914-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REINHOLD LLERENA
Title or Position: CEO
Credential: MD
Phone: 224-273-8908