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Organization
MEDICAL ASSOCIATES OF ILLINOIS SC
Active
Organization
MEDICAL ASSOCIATES OF ILLINOIS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FREDERICK MARVIN TIESENGA M.D. (PRESIDENT)
(708) 452-2800
Entity
Organization
Contact information
Practice address
1950 N HARLEM AVE, ELMWOOD PARK, IL 60707-3717
(708) 452-2800
(708) 452-7515
Mailing address
1950 N HARLEM AVE, ELMWOOD PARK, IL 60707-3717
(708) 452-2800
(708) 452-7515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
05/10/2013
Last updated
02/06/2014
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