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NPI Code Detail

MEDICARE: PERSONALLY PAM LTD

MEDICARE: PERSONALLY PAM 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
1251E00000XHome Health AgencyIL1002666IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19806OTHERILBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1891739629
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERSONALLY PAM LTD
Provider Business Mailing Address
First Line : 10436 S KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2018
Country : US
Telephone Number : 773-233-3337
Fax Number : 773-233-5630
Provider Business Practice Location Address
First Line : 10436 S KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2018
Country : US
Telephone Number : 773-233-3337
Fax Number : 773-233-5630
Authorized Official
Title or Position : PRESIDENT
Name : MR. MICHAEL ALLEN TROST
Credential :
Telephone Number : 773-233-3337
Provider Enumeration Date : 06/15/2006
Last Update Date : 08/22/2020

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Directions to “PERSONALLY PAM LTD ” Practice Location

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