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General NPI Number Information
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NPI Number | 1588843411
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Entity Type | Organization
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Legal Business Name | ESTELLE FLETCHER MD PHD FAMILY DOCTOR S.C.
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Dates
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Enumeration Date | 10/27/2007
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 99- 129TH INFANTRY DRIVE
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City | JOLIET
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State | IL
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Zip | 60435-5134
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Country | US
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Telephone | 815-744-3335
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Fax | 815-744-3701
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Provider Business Mailing Address
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Address Line | 99- 129TH INFANTRY DRIVE
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City | JOLIET
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State | IL
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Zip | 60435-5134
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Country | US
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Telephone | 815-744-3335
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Fax | 815-744-3701
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ESTELLE S FLETCHER
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Credential | MD
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Telephone | 815-744-3335
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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 | 036-089471
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License Number State | IL
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