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General NPI Number Information
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NPI Number | 1154353753
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 125 S WILKE RD SUITE 100
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-1534
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Country | US
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Telephone | 847-637-1600
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Fax | 847-637-1606
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Provider Business Mailing Address
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Address Line | 125 S WILKE RD SUITE 100
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-1534
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Country | US
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Telephone | 847-637-1600
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Fax | 847-637-1606
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Authorized Official
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Title or Position | PRESIDENT
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Name | GAIL G BRYANT
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Credential | M.D.
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Telephone | 847-637-1600
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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 | 036098963
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License Number State | IL
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