Healthcare Provider Details

I. General information

NPI: 1407005671
Provider Name (Legal Business Name): TOWN OF CICERO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 S 49TH AVE
CICERO IL
60804-2460
US

IV. Provider business mailing address

4949 W CERMAK RD
CICERO IL
60804
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-3600
  • Fax: 708-652-7480
Mailing address:
  • Phone: 708-656-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD L SCHULTZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 708-656-3600