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Organization
MIINEDOCTOR, INC.
Active
Organization
MIINEDOCTOR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY ROCK (DIRECTOR OF CLINICAL OPERATIONS)
(708) 972-7636
Entity
Organization
Contact information
Practice address
13755 CICERO AVE, CRESTWOOD, IL 60418-1824
(708) 972-7642
(708) 925-9179
Mailing address
13755 CICERO AVE, CRESTWOOD, IL 60418-1824
(708) 972-7636
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
10/04/2018
Last updated
12/17/2021
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