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General NPI Number Information
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NPI Number | 1861750036
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Entity Type | Organization
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Legal Business Name | D.O.C, FAMILY PRACTICE, S.C.
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 6300 ROOSEVELT RD
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City | OAK PARK
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State | IL
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Zip | 60304-2303
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Country | US
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Telephone | 708-383-6333
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Fax | 708-383-6347
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Provider Business Mailing Address
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Address Line | PO BOX 2294
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City | OAK PARK
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State | IL
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Zip | 60303-2294
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Country | US
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Telephone | 708-383-6333
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Fax | 708-383-6347
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRYSTAL ANN PEOPLES
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Credential | M.D.
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Telephone | 708-383-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036075404
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License Number State | IL
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