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NPI Code Detail

MEDICARE: CRESTWOOD ASSOCIATED MEDICAL CENTER LTD

MEDICARE: CRESTWOOD ASSOCIATED MEDICAL CENTER LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor038010310IL
2207X00000XOrthopaedic Surgery Physician036039801IL
3261QP2000XPhysical Therapy Clinic/Center070.005243IL
4207Q00000XFamily Medicine Physician036.103914IL

General Provider Information

NPI Number : 1104341163
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESTWOOD ASSOCIATED MEDICAL CENTER LTD
Provider Business Mailing Address
First Line : 13705 S. CICERO AVE.
Second Line :
City : CRESTWOOD
State : IL
Zip : 60445
Country : US
Telephone Number : 708-385-4416
Fax Number : 708-388-8825
Provider Business Practice Location Address
First Line : 13705 CICERO AVE
Second Line :
City : CRESTWOOD
State : IL
Zip : 60418-1824
Country : US
Telephone Number : 708-385-4416
Fax Number : 708-388-8825
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOHN WILLIAM REVELLO
Credential : D.C.
Telephone Number : 708-385-4416
Provider Enumeration Date : 08/10/2017
Last Update Date : 07/21/2022

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Directions to “CRESTWOOD ASSOCIATED MEDICAL CENTER LTD ” Practice Location

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