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General NPI Number Information
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NPI Number | 1346423399
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Entity Type | Organization
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Legal Business Name | SPS FAMILY CARE, S.C.
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 1810 W CHICAGO AVE
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City | CHICAGO
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State | IL
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Zip | 60622-5512
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Country | US
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Telephone | 773-489-6100
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Fax | 773-489-6156
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Provider Business Mailing Address
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Address Line | 750 PEARSON ST 507
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City | DES PLAINES
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State | IL
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Zip | 60016-9211
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Country | US
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Telephone | 773-619-0127
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Fax | 847-635-2002
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Authorized Official
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Title or Position | FAMILY PRACTICE
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Name | SORVEIN PRIETO
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Credential | M.D.
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Telephone | 773-619-0127
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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 | 036118602
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License Number State | IL
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