# SELECT MED NETWORK

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093453086
- **Authorized official:** VICKY CHIAKULAS (PRESIDENT)
- **Authorized official phone:** (847) 687-9535

## Contact information

- **Practice address:** 901 N QUINCE LN, MOUNT PROSPECT, IL 60056-1501
- **Practice address phone:** (847) 687-9535
- **Mailing address:** 9 S ELMHURST RD UNIT 350, PROSPECT HEIGHTS, IL 60070-7912
- **Mailing address phone:** (847) 687-9535

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1800X | Corporate Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/20/2022
- **Last updated:** 06/01/2022