Organization
NGR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH ROMERO (OFFICE MANAGER)
(773) 791-1048
Entity
Organization
Contact information
Practice address
1111 SUPERIOR ST, SUITE 304, MELROSE PARK, IL 60160-4156
(708) 786-7100
(708) 786-7101
Mailing address
1111 SUPERIOR ST STE 304, MELROSE PARK, IL 60160-4156
(708) 786-7100
(708) 786-7101
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036078622
STATE LICENCE
IL
Enumeration date
02/28/2020
Last updated
02/28/2020
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