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Organization
GLEN MORTON MEDICAL CENTER, S.C.
Active
Organization
GLEN MORTON MEDICAL CENTER, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA M KRUEGER R.N., O.C.N. (PRACTICE MANAGER)
(847) 965-3200
Entity
Organization
Contact information
Practice address
9129 WAUKEGAN RD, MORTON GROVE, IL 60053-2120
(847) 965-3200
(847) 965-3270
Mailing address
9129 WAUKEGAN RD, MORTON GROVE, IL 60053-2120
(847) 965-3200
(847) 965-3301
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
042006744
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042-006744
MEDICAL CORP.LICENSE
IL
01
—
966420
MEDICARE GROUP
IL
Enumeration date
08/12/2006
Last updated
12/15/2009
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