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General NPI Number Information
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NPI Number | 1922414358
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Entity Type | Organization
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Legal Business Name | MEDINTEL PC
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 532 LOCKARD LN
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City | HIGHWOOD
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State | IL
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Zip | 60040-1223
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Country | US
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Telephone | 773-750-9696
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Fax | 224-848-6296
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Provider Business Mailing Address
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Address Line | 532 LOCKARD LN
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City | HIGHWOOD
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State | IL
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Zip | 60040-1223
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Country | US
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Telephone | 773-750-9696
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Fax | 224-848-6296
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Authorized Official
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Title or Position | PRESIDENT
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Name | NELLY KVIRIKADZE
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Credential | MD
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Telephone | 773-750-9696
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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 | 036114198
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License Number State | IL
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