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General NPI Number Information
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NPI Number | 1639306640
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Entity Type | Organization
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Legal Business Name | OTERO MEDICAL CENTER, S.C.
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 4911 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60639-2505
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Country | US
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Telephone | 773-772-4900
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Fax | 773-772-0298
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Provider Business Mailing Address
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Address Line | 4911 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60639-2505
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Country | US
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Telephone | 773-772-4900
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Fax | 773-772-0298
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM E OTERO
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Credential | MD
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Telephone | 773-772-4900
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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 | 036102552
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License Number State | IL
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