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
7447 W TALCOTT AVE, SUITE 467, CHICAGO, IL 60631-3745
(773) 763-1126
(773) 594-8487
Mailing address
1000 REMINGTON BOULEVARD, BOLINGBROOK, IL 60440-0000
(630) 914-2417
(630) 914-2499
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093242
—
IL
05
—
036109242
—
IL
Enumeration date
09/07/2006
Last updated
04/10/2013
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