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General NPI Number Information
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NPI Number | 1043612427
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Entity Type | Organization
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Legal Business Name | MALDONADO & O'CONNELL
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Dates
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Enumeration Date | 09/17/2014
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 1921 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60616-1603
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Country | US
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Telephone | 312-328-9220
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Fax | 312-328-9970
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Provider Business Mailing Address
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Address Line | 1921 S MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60616-1603
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Country | US
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Telephone | 312-328-9220
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Fax | 312-328-9970
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Authorized Official
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Title or Position | FACILITY MANAGER
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Name | MR. LUIS MALDONADO
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Credential | P.T.
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Telephone | 312-328-9220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 070021030
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License Number State | IL
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