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General NPI Number Information
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NPI Number | 1568122174
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Entity Type | Organization
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Legal Business Name | SOL MED LLC
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 7531 S STONY ISLAND AVE STE 164
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City | CHICAGO
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State | IL
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Zip | 60649-3954
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Country | US
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Telephone | 773-947-2831
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S PRAIRIE AVE APT 4304
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City | CHICAGO
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State | IL
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Zip | 60605-3552
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Country | US
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Telephone | 773-947-2831
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEMBERLY BRIGGS
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Credential | MD
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Telephone | 850-251-8547
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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 |
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License Number State |
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