MEDICARE: PROHEALTH PREVENTION LLC

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
1	261Q00000X	Clinic/Center
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518323195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH PREVENTION LLC

Provider Business Mailing Address
First Line	:	1943 S MAY ST
Second Line	:	1F
City	:	CHICAGO
State	:	IL
Zip	:	60608-3359
Country	:	US
Telephone Number	:	312-549-8866
Fax Number	:	312-549-8861

Provider Business Practice Location Address
First Line	:	1943 S MAY ST
Second Line	:	1F
City	:	CHICAGO
State	:	IL
Zip	:	60608-3359
Country	:	US
Telephone Number	:	312-549-8866
Fax Number	:	312-549-8861

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MRS. JULIA NICOLINI
Credential	:
Telephone Number	:	574-993-7992

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	02/10/2021

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Directions to “PROHEALTH PREVENTION LLC ” Practice Location

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