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Organization

BLUE DIAMOND HEALTH CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JAMES L VACRACOS (BUSINESS REPRESENTATIVE)
(773) 292-9660
Entity
Organization

Contact information

Practice address
2749 W NORTH AVE, CHICAGO, IL 60647-5246
(773) 292-9660
Mailing address
8606 DELAWARE ST, HIGHLAND, IN 46322-1776
(219) 765-3431

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036085675
IL
Enumeration date
08/18/2009
Last updated
08/18/2009
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