Healthcare Provider Details

I. General information

NPI: 1588847784
Provider Name (Legal Business Name): TINLEY WOODS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 S CICERO AVE
OAK LAWN IL
60453-5205
US

IV. Provider business mailing address

18210 LA GRANGE RD SUITE 201
TINLEY PARK IL
60487-7722
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-1202
  • Fax: 708-424-1395
Mailing address:
  • Phone: 708-424-1202
  • Fax: 708-424-1395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. DEBORAH ANN OMALLEY
Title or Position: BILLING MANAGER
Credential: MRS.
Phone: 708-424-1202