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General NPI Number Information
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NPI Number | 1154590305
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Entity Type | Organization
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Legal Business Name | UNIFIED THERAPEUTICS LLC
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 3561 S KING DR
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City | CHICAGO
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State | IL
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Zip | 60653-1136
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Country | US
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Telephone | 312-479-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 3561 S KING DR
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City | CHICAGO
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State | IL
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Zip | 60653-1136
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Country | US
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Telephone | 312-479-7744
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Fax |
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Authorized Official
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Title or Position | FINANCIAL OFFICER
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Name | TODD OCCOMY
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Credential |
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Telephone | 312-479-7744
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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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