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General NPI Number Information
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NPI Number | 1538105390
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Entity Type | Organization
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Legal Business Name | CRETICOS ID ASSOCIATES SC
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 836 W WELLINGTON AVE
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City | CHICAGO
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State | IL
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Zip | 60657-5147
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Country | US
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Telephone | 773-296-7039
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Fax | 773-296-7909
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Provider Business Mailing Address
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Address Line | 777 OAKMONT LN SUITE 1600
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City | WESTMONT
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State | IL
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Zip | 60559-5511
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Country | US
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Telephone | 630-789-2550
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CATHERINE M CRETICOS
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Credential | MD
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Telephone | 773-296-7039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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