Organization
NOCD ILLINOIS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY TRUSKY (COO)
(312) 569-0820
Entity
Organization
Contact information
Practice address
6160 N CICERO AVE, CHICAGO, IL 60646
(312) 569-0820
Mailing address
225 N MICHIGAN AVE STE 1430, CHICAGO, IL 60601-7653
(312) 569-0820
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
04/02/2020
Last updated
04/07/2020
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