Organization
SAINT ANTHONY PHO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AILEEN M BROOKS (EXECUTIVE COMMITTEE MEMBER)
(773) 484-4015
Entity
Organization
Contact information
Practice address
2875 W 19TH ST, CHICAGO, IL 60623-3501
(773) 484-4015
Mailing address
2875 W 19TH ST, CHICAGO, IL 60623-3501
(773) 484-4015
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
09/07/2011
Last updated
09/07/2011
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