Healthcare Provider Details

I. General information

NPI: 1396848222
Provider Name (Legal Business Name): WEST SUBURBAN HEALTH PROVIDERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 03/27/2012
Certification Date: WEST SUBURBAN HEALTH PROVIDERS, INC 2433 N HARLEM AVE CHICAGO IL 60707 2433 N HARLEM AVE CHICAGO IL 60707
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 N HARLEM AVE SUITE 300
CHICAGO IL
60707-2031
US

IV. Provider business mailing address

2433 N HARLEM AVE SUITE 300
CHICAGO IL
60707-2031
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-7362
  • Fax: 773-745-7493
Mailing address:
  • Phone: 800-974-7362
  • Fax: 773-745-7493

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. TOD R ERICKSON
Title or Position: CEO
Credential:
Phone: 773-564-6301