Organization
IHC-SWEDISHAMERICAN EMERGENCY PHYSICIANS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN KONDAS (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
1401 E STATE ST, ROCKFORD, IL 61104-2315
(414) 290-6718
(414) 290-6755
Mailing address
PO BOX 80274, PHILADELPHIA, PA 19101-1274
(414) 290-6718
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125363600
OWCP
IL
01
—
130009490
WEA
WI
01
—
204472
FEDERAL BLACK LUNG PROGRA
IL
05
—
21278000
—
WI
05
—
913948600
—
FL
01
—
DA2648
MEDICARE RAILROAD
IL
Enumeration date
05/05/2006
Last updated
12/09/2019
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