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NPI Code Detail

MEDICARE: GENESIS CLINICAL SERVICES

MEDICARE: GENESIS CLINICAL SERVICES
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
1261QM1300XMulti-Specialty Clinic/CenterIL

General Provider Information

NPI Number : 1265432140
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESIS CLINICAL SERVICES
Provider Business Mailing Address
First Line : 1725 S NAPERVILLE RD
Second Line : SUITE 206
City : WHEATON
State : IL
Zip : 60187-8155
Country : US
Telephone Number : 630-653-6441
Fax Number : 630-653-8409
Provider Business Practice Location Address
First Line : 1725 S NAPERVILLE RD
Second Line : SUITE 206
City : WHEATON
State : IL
Zip : 60187-8155
Country : US
Telephone Number : 630-653-6441
Fax Number : 630-653-8409
Authorized Official
Title or Position : PRESIDENT
Name : RALPH M ORLAND
Credential : M.D.
Telephone Number : 630-653-6441
Provider Enumeration Date : 07/21/2005
Last Update Date : 08/22/2020

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Directions to “GENESIS CLINICAL SERVICES ” Practice Location

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