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Organization
PROGRESSIVE MEDICAL CENTER SC
Active
Organization
PROGRESSIVE MEDICAL CENTER SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GABRIELA HENRIQUEZ (OFFICE MANAGER)
(630) 238-9235
Entity
Organization
Contact information
Practice address
414 W LAKE STREET, ADDISON, IL 60101
(630) 458-1905
(630) 458-1908
Mailing address
1841 W ARMY TRAIL RD, ADDISON, IL 60101-1901
(630) 238-9235
(630) 620-0581
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036103673
IL
207Q00000X
Family Medicine Physician
036107571
IL
207R00000X
Internal Medicine Physician
Primary
036087152
IL
208000000X
Pediatrics Physician
036078267
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036078267
—
IL
05
—
036087152
—
IL
05
—
036103673
—
IL
05
—
036109448
—
IL
01
—
2205538
BCBS OF ILLINOIS
IL
Enumeration date
01/12/2007
Last updated
04/07/2011
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