# KISHWAUKEE CORPORATE HEALTH @MOI

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

## Provider details

- **NPI number:** 1467841809
- **Authorized official:** DR. PATRICK G GANNON DO (PHYSICIAN)
- **Authorized official phone:** (815) 754-4882

## Contact information

- **Practice address:** 2111 MIDLANDS CT, SUITE 201, SYCAMORE, IL 60178-3125
- **Practice address phone:** (181) 575-4488
- **Mailing address:** 2111 MIDLANDS CT, SUITE 201, SYCAMORE, IL 60178
- **Mailing address phone:** (181) 575-4488

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | 036-077643 | IL | Yes |

## Other

- **Enumeration date:** 01/22/2015
- **Last updated:** 01/22/2015