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General NPI Number Information
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NPI Number | 1578244307
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Entity Type | Organization
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Legal Business Name | FIRSTHAND HEALTH OF ILLINOIS, P.C.
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 33 S ABERDEEN ST APT 209
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City | CHICAGO
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State | IL
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Zip | 60607-3763
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Country | US
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Telephone | 844-378-4263
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Fax | 855-384-1969
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Provider Business Mailing Address
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Address Line | 524 BROADWAY FL 11
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City | NEW YORK
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State | NY
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Zip | 10012-4471
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Country | US
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Telephone | 844-378-4263
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Fax | 855-384-1969
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Authorized Official
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Title or Position | CHIEF MEDICAL DIRECTOR
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Name | JOSEPH J PARKS
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Credential | MD
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Telephone | 844-378-4263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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