Healthcare Provider Details

I. General information

NPI: 1174415376
Provider Name (Legal Business Name): EPIC MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17465 KEDZIE AVE
HAZEL CREST IL
60429-1632
US

IV. Provider business mailing address

17465 KEDZIE AVE
HAZEL CREST IL
60429-1632
US

V. Phone/Fax

Practice location:
  • Phone: 708-887-7329
  • Fax: 129-552-2688
Mailing address:
  • Phone: 708-887-7329
  • Fax: 129-552-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN A FLICK
Title or Position: AUTHORIZE OFFICIAL
Credential: DO
Phone: 708-887-7329