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General NPI Number Information
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NPI Number | 1437693355
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Entity Type | Organization
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Legal Business Name | AR TELEMEDICINE OF ILLINOIS SC
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 4336 ENFIELD AVE
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City | SKOKIE
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State | IL
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Zip | 60076-1806
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Country | US
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Telephone | 855-629-8353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 663
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City | WORTH
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State | IL
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Zip | 60482-0663
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Country | US
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Telephone | 855-629-8353
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TAMMY TIMM
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Credential |
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Telephone | 708-878-2833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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