Loreli Munford, | |
10100 Forest Hills Rd, Machesney Park, IL 61115-8234 | |
(815) 713-2742 | |
(815) 282-8597 |
Full Name | Loreli Munford |
---|---|
Gender | Female |
Speciality | Internal Medicine |
Location | 10100 Forest Hills Rd, Machesney Park, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1275591430 | NPI | - | NPPES |
284141 | Medicaid | SC | |
036-120782 | Other | IL | ILLINOIS STATE LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 28414 (South Carolina) | Secondary |
207R00000X | Internal Medicine | 036-120782 (Illinois) | Primary |
Entity Name | Munford Medical Care Services Mmcs Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1295089928 PECOS PAC ID: 2062663008 Enrollment ID: O20121121000310 |
Entity Name | Physicians Services Group Pc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1700357076 PECOS PAC ID: 7618215690 Enrollment ID: O20190218001221 |
Entity Name | Centerwell Senior Primary Care Sc Pc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1376907790 PECOS PAC ID: 2860804796 Enrollment ID: O20201216002926 |
Entity Name | Centerwell Senior Primary Care Sc Jv Pc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1962101501 PECOS PAC ID: 5294190252 Enrollment ID: O20230426000585 |
Mailing Address | Practice Location Address |
---|---|
Loreli Munford, 10100 Forest Hills Rd, Machesney Park, IL 61115-8234 Ph: (815) 713-2742 | Loreli Munford, 10100 Forest Hills Rd, Machesney Park, IL 61115-8234 Ph: (815) 713-2742 |