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General NPI Number Information
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NPI Number | 1417259979
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Entity Type | Organization
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Legal Business Name | ADOLESCENT AND YOUNG ADULT PLACE LTD
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 9 N CICERO AVE
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City | CHICAGO
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State | IL
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Zip | 60644-3602
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Country | US
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Telephone | 312-859-2491
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 795
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City | HILLSIDE
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State | IL
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Zip | 60162-0795
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Country | US
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Telephone | 708-544-6553
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARGO ANTOINETTE BELL
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Credential | M.D.
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Telephone | 312-859-2491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 036086432
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License Number State | IL
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