Healthcare Provider Details

I. General information

NPI: 1881411791
Provider Name (Legal Business Name): FIDDLE LEAF HEALTH ARKANSAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S MICHIGAN AVE STE 305
CHICAGO IL
60616-2857
US

IV. Provider business mailing address

2600 S MICHIGAN AVE STE 305
CHICAGO IL
60616-2857
US

V. Phone/Fax

Practice location:
  • Phone: 312-371-7951
  • Fax:
Mailing address:
  • Phone: 312-371-7951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY DEL PRIORE
Title or Position: PARTNER
Credential:
Phone: 312-371-7951