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General NPI Number Information
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NPI Number | 1417992306
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Entity Type | Organization
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Legal Business Name | WESTERN SPRINGS FAMILY PRACTICE CENTER, LTD.
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 5600 WOLF RD
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-2254
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Country | US
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Telephone | 708-246-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 WOLF RD SUITE 140
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-2254
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Country | US
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Telephone | 708-246-7222
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | KAREN RODGERS
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Credential |
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Telephone | 708-246-7222
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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 | 42005694
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License Number State | IL
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