Healthcare Provider Details

I. General information

NPI: 1497060024
Provider Name (Legal Business Name): OAK LAWN IMMEDIATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 W 95TH ST
OAK LAWN IL
60453-2615
US

IV. Provider business mailing address

4201 W 95TH ST
OAK LAWN IL
60453-2615
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-7661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number036085357
License Number StateIL

VIII. Authorized Official

Name: DR. JERZY SZYMANSKI
Title or Position: OWNER
Credential: MD
Phone: 773-735-8038