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General NPI Number Information
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NPI Number | 1952606147
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Entity Type | Organization
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Legal Business Name | BOLSEN HEALTH CENTER
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Dates
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Enumeration Date | 01/19/2011
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 150 E SCHILLER ST APT 506
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City | ELMHURST
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State | IL
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Zip | 60126-2852
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Country | US
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Telephone | 630-833-5732
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Fax | 630-833-5742
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Provider Business Mailing Address
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Address Line | 6429 .W. NORTH AVENUE , SUITE 106
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City | OAK PARK
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State | IL
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Zip | 60302
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Country | US
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Telephone | 708-763-8334
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Fax | 630-833-5742
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BENJAMIN ATTEH OKAI
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Credential | M.D.
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Telephone | 708-763-8334
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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 | D046435
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License Number State | IL
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