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411 Madison St Maywood IL 60153-2136 | |
| (708) 236-5042 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 411 Madison St, Maywood, Illinois |
| Authorized Official Name and Position | Claude Porter (CEO) |
| Authorized Official Contact | 7084503500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
411 West Madison Street Maywood IL 60153 Ph: (708) 236-5042 | 411 Madison St Maywood IL 60153-2136 Ph: (708) 236-5042 |
| NPI Number | 1134553076 |
|---|---|
| Provider Enumeration Date | 08/28/2013 |
| Last Update Date | 03/20/2024 |
| Certification Date | 03/20/2024 |
| Medicare PECOS PAC ID | 3870823024 |
|---|---|
| Medicare Enrollment ID | O20240627003351 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134553076 | NPI | - | NPPES |
| 1215987003 | Medicaid | IL |
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