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General NPI Number Information
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NPI Number | 1578793816
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Entity Type | Organization
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Legal Business Name | CENTER FOR FAMILY HEALTH
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 165 E PLANK RD
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City | SYCAMORE
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State | IL
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Zip | 60178-8757
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Country | US
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Telephone | 815-752-3253
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Fax | 815-752-3277
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Provider Business Mailing Address
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Address Line | 165 E PLANK RD
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City | SYCAMORE
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State | IL
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Zip | 60178-8757
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Country | US
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Telephone | 815-752-3253
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Fax | 815-752-3277
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Authorized Official
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Title or Position | CEO
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Name | MR. KEVIN POORTEN
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Credential |
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Telephone | 815-756-1521
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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 | IL
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