Healthcare Provider Details

I. General information

NPI: 1275726085
Provider Name (Legal Business Name): PRESTON HEALTH PARTNERS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4479 CENTRAL AVE
WESTERN SPRINGS IL
60558-1714
US

IV. Provider business mailing address

4479 CENTRAL AVE
WESTERN SPRINGS IL
60558-1714
US

V. Phone/Fax

Practice location:
  • Phone: 708-784-9000
  • Fax: 708-784-9088
Mailing address:
  • Phone: 708-784-9000
  • Fax: 708-784-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number036080973
License Number StateIL

VIII. Authorized Official

Name: DR. REBECCA C PRESTON
Title or Position: OWNER
Credential: MD
Phone: 708-784-9000