MEDICARE: REGIONAL HEALTCARE GROUP, 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
1	208D00000X	General Practice Physician		IL
2	208D00000X	General Practice Physician		IL

General Provider Information

NPI Number	:	1932200425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL HEALTCARE GROUP, LTD

Provider Business Mailing Address
First Line	:	10325 S WESTERN AVE
Second Line	:	SUITE C
City	:	CHICAGO
State	:	IL
Zip	:	60643-2410
Country	:	US
Telephone Number	:	773-881-9250
Fax Number	:	773-881-9254

Provider Business Practice Location Address
First Line	:	10325 S WESTERN AVE
Second Line	:	SUITE C
City	:	CHICAGO
State	:	IL
Zip	:	60643-2410
Country	:	US
Telephone Number	:	773-881-9250
Fax Number	:	773-881-9254

Authorized Official
Title or Position	:	OFFICER
Name	:	MARLYNE JEAN-PIERRE
Credential	:
Telephone Number	:	773-881-9250

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/22/2020

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