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Organization
JOHN R DEFOREST D.O. S.C.
Active
Organization
JOHN R DEFOREST D.O. S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN RUCKMAN (ACCT REP.)
(708) 946-3990
Entity
Organization
Contact information
Practice address
715 S DIXIE HWY, BEECHER, IL 60401-3668
(708) 946-9330
(708) 946-2471
Mailing address
715 S DIXIE HWY, BEECHER, IL 60401-3668
(708) 946-9330
(708) 946-2471
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
336051704
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360899981
—
IL
01
—
080154175
RAILROAD MEDICARE
IL
01
—
9925692
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/22/2006
Last updated
12/10/2014
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