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General NPI Number Information
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NPI Number | 1487983060
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL CENTER OF DWIGHT PC
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 103 S JOHN ST
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City | DWIGHT
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State | IL
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Zip | 60420-1413
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Country | US
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Telephone | 815-584-3051
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Fax |
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Provider Business Mailing Address
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Address Line | 103 S JOHN ST
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City | DWIGHT
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State | IL
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Zip | 60420-1413
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Country | US
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Telephone | 815-584-3051
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PAMELA MARIE CICHON
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Credential |
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Telephone | 815-584-3051
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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 | 036062435
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License Number State | IL
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