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Organization
MOKENA FAMILY PHYSICIANS LLC
Active
Organization
MOKENA FAMILY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA A DAVIS (MANAGER)
(708) 479-4681
Entity
Organization
Contact information
Practice address
11243 W LA PORTE RD, MOKENA, IL 60448-1374
(708) 479-4681
(708) 479-8516
Mailing address
11243 W LA PORTE RD, MOKENA, IL 60448-1374
(708) 479-4681
(708) 479-8516
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
036085722
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077425
—
IL
05
—
036085722
—
IL
Enumeration date
11/06/2006
Last updated
06/25/2013
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