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Organization
BETHANY HOMES AND METHODIST HOSPITAL
Active
Organization
BETHANY HOMES AND METHODIST HOSPITAL
Active
Other names
Egel Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAMILLA LARSEN M.D. (MEDICAL DIRECTOR)
(773) 653-5630
Entity
Organization
Contact information
Practice address
5113 N CLARK ST, CHICAGO, IL 60640-2807
(773) 293-4090
(773) 293-4503
Mailing address
5113 N CLARK ST, CHICAGO, IL 60640-2807
(773) 293-4090
(773) 293-4503
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036108645
IL
Other
Enumeration date
12/06/2012
Last updated
12/20/2012
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