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General NPI Number Information
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NPI Number | 1548820194
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Entity Type | Organization
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Legal Business Name | RIVERFRONT MEDICAL, LLC
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 103 N MAIN ST
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City | PORT BYRON
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State | IL
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Zip | 61275-7705
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Country | US
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Telephone | 312-422-4035
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Fax |
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Provider Business Mailing Address
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Address Line | 303 W MADISON ST STE 1000
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City | CHICAGO
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State | IL
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Zip | 60606-3321
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Country | US
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Telephone | 312-263-8600
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Fax |
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Authorized Official
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Title or Position | LEGAL COUNSEL
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Name | MS. MORI HALL
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Credential | JD, LLM, CHC
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Telephone | 312-263-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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