Healthcare Provider Details

I. General information

NPI: 1053347484
Provider Name (Legal Business Name): SWEDISH COVENANT PHYSICIAN PARTNERS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE SUITE 411
CHICAGO IL
60625-3500
US

IV. Provider business mailing address

2740 W FOSTER AVE SUITE 411
CHICAGO IL
60625-3500
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-0880
  • Fax:
Mailing address:
  • Phone: 773-271-0880
  • Fax:

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: MR. CAREY CULLY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 773-271-0880