# MOKENA FAMILY PHYSICIANS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740359876
- **Authorized official:** RHONDA A DAVIS (MANAGER)
- **Authorized official phone:** (708) 479-4681

## Contact information

- **Practice address:** 11243 W LA PORTE RD, MOKENA, IL 60448-1374
- **Practice address phone:** (708) 479-4681
- **Practice address fax:** (708) 479-8516
- **Mailing address:** 11243 W LA PORTE RD, MOKENA, IL 60448-1374
- **Mailing address phone:** (708) 479-4681
- **Mailing address fax:** (708) 479-8516

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 036085722 | IL | Yes |

## Other

- **Enumeration date:** 11/06/2006
- **Last updated:** 06/25/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036077425 | — | IL |
| 05 | — | 036085722 | — | IL |