Unknown Individual – Family Medicine Physician, NPI 1790723088
Family Medicine Physician
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
2850, West 95th Street, Evergreen Park, Worth Township, Cook County, Illinois, 60805, United States
SUITE 102
EVERGREEN PARK, IL 608052735
Phone: (708) 226-1206
Fax: (708) 229-6085
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60805)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | IL | |
| - | IL | |
| - | TN | |
| - | IL | |
| - | IL | |
| - | IL | |
| - | IL | |
| - | IL | |
| Physician Assistant | MO | |
| - | IL |
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