Healthcare Provider Details

I. General information

NPI: 1427731645
Provider Name (Legal Business Name): SOUTH LOOP INTEGRATED PHYSICIANS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 S WABASH AVE
CHICAGO IL
60605-2346
US

IV. Provider business mailing address

1147 S WABASH AVE
CHICAGO IL
60605-2346
US

V. Phone/Fax

Practice location:
  • Phone: 312-987-4878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES MORGAN
Title or Position: MANAGER
Credential:
Phone: 239-970-2484