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General NPI Number Information
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NPI Number | 1780830323
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Entity Type | Organization
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Legal Business Name | PROCARE MEDICAL CENTER OF OAK PARK S.C.
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Dates
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Enumeration Date | 08/14/2008
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 6715 NORTH AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1006
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Country | US
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Telephone | 708-386-9600
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Fax | 708-386-6558
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Provider Business Mailing Address
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Address Line | 6715 NORTH AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1006
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Country | US
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Telephone | 708-386-9600
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Fax | 708-386-6558
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. ALLAN MOMNEY
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Credential |
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Telephone | 708-386-9600
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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 | 036094250
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License Number State | IL
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