Healthcare Provider Details

I. General information

NPI: 1497213110
Provider Name (Legal Business Name): SOLLEY'S MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4239 W 95TH ST
OAK LAWN IL
60453-2623
US

IV. Provider business mailing address

4239 W 95TH ST
OAK LAWN IL
60453-2623
US

V. Phone/Fax

Practice location:
  • Phone: 708-529-0188
  • Fax:
Mailing address:
  • Phone: 708-529-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAT BRETT
Title or Position: OWNER
Credential: CADC
Phone: 708-529-0188