Healthcare Provider Details

I. General information

NPI: 1902913403
Provider Name (Legal Business Name): MEDICAL ARTS FAMILY PHYSICIANS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N GREENLEAF ST SUITE 100
GURNEE IL
60031-3393
US

IV. Provider business mailing address

135 NORTH GREENLEAF SUITE 100
GURNEE IL
60031-3334
US

V. Phone/Fax

Practice location:
  • Phone: 847-244-7223
  • Fax: 847-244-7247
Mailing address:
  • Phone: 847-244-7223
  • Fax: 847-244-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036096722
License Number StateIL

VIII. Authorized Official

Name: DR. DANNY K VU
Title or Position: PRESIDENT OF CORPORATION
Credential: MD
Phone: 847-244-7223