Organization
MEDICAL AND REHABABILITATION CENTER OF CHICAGO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MALCOM D HERZOG DPM (MANAGER)
(708) 380-7028
Entity
Organization
Contact information
Practice address
5241 S CICERO AVE, CHICAGO, IL 60632-4967
(773) 284-8811
(773) 284-6431
Mailing address
5241 S CICERO AVE, CHICAGO, IL 60632-4967
(773) 284-8811
(773) 284-6431
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
616225000
DOWL
IL
Enumeration date
03/07/2014
Last updated
03/07/2014
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