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General NPI Number Information
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NPI Number | 1669964300
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Entity Type | Organization
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Legal Business Name | FAVIA PRIMARY CARE, SC
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 1340 RYAN PARKWAY
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City | ALGONQUIN
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State | IL
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Zip | 60102
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Country | US
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Telephone | 815-276-0150
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 336
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City | ALGONQUIN
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State | IL
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Zip | 60102-0336
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Country | US
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Telephone | 815-276-0150
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP FAVIA
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Credential | MD
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Telephone | 815-276-0150
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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 | 036-111767
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License Number State | IL
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