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Organization
TYCO MEDICAL CLINIC LTD
Active
Organization
TYCO MEDICAL CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLA COURTNEY MD (PRESIDENT)
(773) 484-1000
Entity
Organization
Contact information
Practice address
2875 W 19TH ST, CHICAGO, IL 60623-3501
(773) 484-1000
Mailing address
2875 W 19TH ST, CHICAGO, IL 60623-3501
(773) 484-1000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036749530
IL
Other
Enumeration date
05/18/2009
Last updated
05/18/2009
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