MEDICARE: VALENTINALB,S.C.

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	207Q00000X	Family Medicine Physician

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	:	1548541022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALENTINALB,S.C.

Provider Business Mailing Address
First Line	:	4727 N CLARK ST STE 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7554
Country	:	US
Telephone Number	:	773-334-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	4727 N CLARK ST STE 1N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-7554
Country	:	US
Telephone Number	:	773-334-9300
Fax Number	:	177-333-4930

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ANNA MORGAN
Credential	:	M.D.
Telephone Number	:	773-334-9300

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	10/22/2024

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Directions to “VALENTINALB,S.C. ” Practice Location

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