| Cicero Medical Clinica San Lazaro Llc | |
|
5712 W 35th St Cicero IL 60804-4222 | |
| (708) 656-5485 | |
| (708) 656-5657 |
| Full Name | Cicero Medical Clinica San Lazaro Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5712 W 35th St, Cicero, Illinois |
| Authorized Official Name and Position | Gerard Licea (REGISTERED AGENT) |
| Authorized Official Contact | 7086565485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cicero Medical Clinica San Lazaro Llc 5712 W 35th St Cicero IL 60804-4222 Ph: (708) 656-5485 | Cicero Medical Clinica San Lazaro Llc 5712 W 35th St Cicero IL 60804-4222 Ph: (708) 656-5485 |
| NPI Number | 1295822716 |
|---|---|
| Provider Enumeration Date | 10/06/2006 |
| Last Update Date | 07/16/2009 |
| Medicare PECOS PAC ID | 0143226324 |
|---|---|
| Medicare Enrollment ID | O20061011000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295822716 | NPI | - | NPPES |
| DF0534 | Other | IL | RAILROAD MEDICARE |
| 0179982 | Other | IL | HEALTHSPRING |
| 1636532 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Rosaura Licea |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548299225 PECOS PAC ID: 4789580721 Enrollment ID: I20040105000094 |
Roselia Herrera Md Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6039 W Cermak Rd, Cicero, IL 60804 Phone: 708-652-0056 | |
Mk Medical Group Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5729 W Cermak Rd, Cicero, IL 60804 Phone: 708-477-6525 | |
Kid Care Doctors Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2240 S Cicero Ave, Cicero, IL 60804 Phone: 708-222-9170 Fax: 708-222-9173 | |
Lr Health Management, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1204 S 57th Ave, Cicero, IL 60804 Phone: 312-375-7145 Fax: 708-652-5424 | |
Cook County Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2423 S Austin Blvd, Cicero, IL 60804 Phone: 708-656-1130 | |
Hernan Reyes Md Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5610 W Cermak Rd, Unit #2, Cicero, IL 60804 Phone: 708-656-9247 Fax: 708-656-9358 | |
Alivio Medical Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4842 W Cermak Rd, Cicero, IL 60804 Phone: 312-829-6304 Fax: 708-660-0349 |