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General NPI Number Information
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NPI Number | 1043355670
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Entity Type | Organization
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Legal Business Name | ROYA FAMILY MEDICAL CENTER LTD
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 05/09/2014
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Provider Practice Location Address
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Address Line | 714 N BROADWAY AVE.
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City | MELROSE PARK
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State | IL
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Zip | 60160
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Country | US
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Telephone | 708-865-0663
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Fax | 708-681-1812
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Provider Business Mailing Address
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Address Line | PO BOX 5140
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City | RIVER FOREST
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State | IL
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Zip | 60305-5140
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Country | US
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Telephone | 708-865-0663
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Fax | 708-681-1812
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELLE ALEXANDRE
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Credential | M.D.
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Telephone | 708-865-0663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036100953
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License Number State | IL
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