Healthcare Provider Details

I. General information

NPI: 1750445987
Provider Name (Legal Business Name): MACNEAL HEALTH PROVIDERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 PASQUINELLI DR SUITE 204
WESTMONT IL
60559-5567
US

IV. Provider business mailing address

750 PASQUINELLI DR SUITE 204
WESTMONT IL
60559-5567
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-3912
  • Fax: 708-783-7190
Mailing address:
  • Phone: 708-783-3912
  • Fax: 708-783-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LOUIS A KARLOVICH
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 708-783-3912