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General NPI Number Information
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NPI Number | 1083905582
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Entity Type | Organization
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Legal Business Name | OAK LAWN IMMEDIATE CARE LLC
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 4201 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2615
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Country | US
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Telephone | 773-754-3500
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Fax | 773-754-3504
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Provider Business Mailing Address
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Address Line | 4201 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-2615
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Country | US
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Telephone | 708-499-7661
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Fax | 773-754-3504
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JERZY SZYMANKSI
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Credential | MD
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Telephone | 708-499-7661
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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 |
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License Number State |
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