Healthcare Provider Details

I. General information

NPI: 1922068477
Provider Name (Legal Business Name): WATERMARK PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7222 W CERMAK RD SUITE 301
NORTH RIVERSIDE IL
60546-1422
US

IV. Provider business mailing address

7222 W CERMAK RD SUITE 301
NORTH RIVERSIDE IL
60546-1422
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-2410
  • Fax: 708-783-2452
Mailing address:
  • Phone: 708-783-2410
  • Fax: 708-783-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. HAYDEE REYES
Title or Position: MANAGER
Credential:
Phone: 708-783-2410