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Organization
GRAND HARLEM MEDICAL CENTER, URGENT CARE LLC
Active
Organization
GRAND HARLEM MEDICAL CENTER, URGENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RENLIN XIA MD (OWNER)
(708) 452-1220
Entity
Organization
Contact information
Practice address
2502 N HARLEM AVE, ELMWOOD PARK, IL 60707-2020
(708) 452-1220
(708) 452-6043
Mailing address
2502 N HARLEM AVE, ELMWOOD PARK, IL 60707-2020
(708) 452-1220
(708) 452-6043
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
038006714
IL
207Q00000X
Family Medicine Physician
036059474
IL
207Q00000X
Family Medicine Physician
036060249
IL
207Q00000X
Family Medicine Physician
Primary
036088691
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036059474
LISCENSE
IL
01
—
036060249
LISCENSE
IL
01
—
036088691
LISCENSE
IL
01
—
038006714
LISCENSE
IL
Enumeration date
02/27/2009
Last updated
06/29/2009
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