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General NPI Number Information
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NPI Number | 1851328546
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Entity Type | Organization
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Legal Business Name | NORYBDEER LIMITED
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 45 W 111TH ST SUITE B
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City | CHICAGO
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State | IL
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Zip | 60628-4247
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Country | US
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Telephone | 773-370-5254
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Fax |
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Provider Business Mailing Address
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Address Line | 519 S 7TH AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-1506
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Country | US
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Telephone | 708-345-9894
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Fax | 708-345-9894
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Authorized Official
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Title or Position | CEO
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Name | MS. SHIRLEY WALKER
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Credential |
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Telephone | 708-345-9894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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