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General NPI Number Information
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NPI Number | 1356725485
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Entity Type | Organization
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Legal Business Name | MOBILE HEALTH TEAM
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Dates
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Enumeration Date | 07/18/2015
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Last Update Date | 07/18/2015
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Provider Practice Location Address
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Address Line | 6257 MCCORMICK BLVD STE 134
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City | CHICAGO
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State | IL
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Zip | 60659-7463
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Country | US
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Telephone | 773-234-1698
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Fax |
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Provider Business Mailing Address
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Address Line | 6257 W. MCCORMICK BLVD SUITE 134
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City | CHICAGO
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State | IL
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Zip | 60659
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Country | US
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Telephone | 773-234-1698
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VICTORY OKORIE
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Credential |
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Telephone | 614-419-7820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 041404508
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License Number State | IL
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