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Organization
COMMUNITY MEDICAL CENTER OF DWIGHT PC
Active
Organization
COMMUNITY MEDICAL CENTER OF DWIGHT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA MARIE CICHON (OFFICE MANAGER)
(815) 584-3051
Entity
Organization
Contact information
Practice address
103 S JOHN ST, DWIGHT, IL 60420-1413
(815) 584-3051
Mailing address
103 S JOHN ST, DWIGHT, IL 60420-1413
(815) 584-3051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036062435
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062435
—
IL
01
—
05315073
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/10/2009
Last updated
02/19/2010
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