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General NPI Number Information
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NPI Number | 1205024791
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Entity Type | Organization
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Legal Business Name | MACNEAL PHYSICIANS GROUP LLC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 3249 OAK PARK AVE
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City | BERWYN
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State | IL
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Zip | 60402-3429
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Country | US
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Telephone | 708-783-3222
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Fax | 708-783-3489
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Provider Business Mailing Address
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Address Line | 20 BURTON HILLS BLVD SUITE 100, ATTENTION, CAROL BAILEY
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City | NASHVILLE
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State | TN
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Zip | 37215-6197
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Country | US
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Telephone | 615-665-6000
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Fax | 615-665-6184
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Authorized Official
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Title or Position | VP OF GOVT PROGRAMS, TENET
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Name | CRAIG C. ARMIN
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Credential |
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Telephone | 818-436-2267
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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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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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