Organization
PRESENCE HEALTHCARE SERVICES
Active
Other names
Presence Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELVONNE WICKLIFFE-JONES (CREDENTIALING MGR)
(630) 914-2417
Entity
Organization
Contact information
Practice address
5600 W ADDISON ST, SUITE 301, CHICAGO, IL 60634-4401
(773) 736-4553
(773) 205-1997
Mailing address
1000 REMINGTON BOULEVARD, SUITE 100, BOLINGBROOK, IL 60440-0000
(630) 914-2417
(630) 914-2499
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067614
—
IL
Enumeration date
02/22/2006
Last updated
04/10/2013
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