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General NPI Number Information
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NPI Number | 1134378789
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Entity Type | Organization
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Legal Business Name | FAMILY DOCTORS OF BROOKFIELD SC
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 8905 BURLINGTON AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-2034
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Country | US
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Telephone | 708-387-7000
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Fax | 708-387-7001
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Provider Business Mailing Address
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Address Line | 8905 BURLINGTON AVE
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City | BROOKFIELD
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State | IL
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Zip | 60513-2034
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Country | US
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Telephone | 708-387-7000
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Fax | 708-387-7001
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GEORGE TOMECKI
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Credential | M.D.
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Telephone | 708-387-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 042618634
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License Number State | IL
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