Healthcare Provider Details

I. General information

NPI: 1851091235
Provider Name (Legal Business Name): ADRIAN TELLEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8317 OGDEN AVE
LYONS IL
60534-1122
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 847-818-0461
  • Fax: 847-305-2917
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.009853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: