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General NPI Number Information
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NPI Number | 1982836680
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Entity Type | Organization
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Legal Business Name | ANGELLA CHARNOT-KATSIKAS, LTD
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 11555 S HARLEM AVE SUITE C
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City | WORTH
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State | IL
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Zip | 60482-2300
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Country | US
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Telephone | 708-691-4472
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Fax | 708-671-1433
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Provider Business Mailing Address
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Address Line | 11555 S HARLEM AVE SUITE C
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City | WORTH
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State | IL
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Zip | 60482-2300
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Country | US
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Telephone | 708-691-4472
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Fax | 708-671-1433
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Authorized Official
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Title or Position | OWNER / MEDICAL DIRECTOR
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Name | DR. ANGELLA CHARNOT-KATSIKAS
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Credential | M.D.
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Telephone | 708-691-4472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 036121904
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License Number State | IL
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