Healthcare Provider Details

I. General information

NPI: 1912200882
Provider Name (Legal Business Name): OBREGON MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 01/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 W CERMAK RD
CICERO IL
60804-2236
US

IV. Provider business mailing address

5533 W CERMAK RD
CICERO IL
60804-2236
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-8775
  • Fax:
Mailing address:
  • Phone: 708-656-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036069552
License Number StateIL

VIII. Authorized Official

Name: FELIX OBREGON
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 708-656-8775