| St Jude Medical Clinic Sc | |
|
3943 W 31st St Chicago IL 60623-4936 | |
| (773) 523-8773 | |
| (773) 523-9259 |
| Full Name | St Jude Medical Clinic Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 3943 W 31st St, Chicago, Illinois |
| Authorized Official Name and Position | Roma Shukla (MANAGER) |
| Authorized Official Contact | 7735238773 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Jude Medical Clinic Sc 3943 W 31st St Chicago IL 60623-4936 Ph: (773) 523-8773 | St Jude Medical Clinic Sc 3943 W 31st St Chicago IL 60623-4936 Ph: (773) 523-8773 |
| NPI Number | 1326186941 |
|---|---|
| Provider Enumeration Date | 02/03/2007 |
| Last Update Date | 01/27/2020 |
| Medicare PECOS PAC ID | 6800072489 |
|---|---|
| Medicare Enrollment ID | O20110516000662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326186941 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Manish Shukla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619983558 PECOS PAC ID: 2062586704 Enrollment ID: I20110516000758 |
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