Organization
BERWYN EMERGENCY SERVICES SC
Active
Other names
Healthstop
Organization subpart
No
Provider details
NPI number
Authorized official
MANOHAR L JETHANI MD (OWNER)
(708) 447-9402
Entity
Organization
Contact information
Practice address
3635 HARLEM AVE, BERWYN, IL 60402-3212
(708) 447-9402
(708) 447-3246
Mailing address
3635 HARLEM AVE, BERWYN, IL 60402-3212
(708) 447-9402
(708) 447-3246
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036046173
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01616688
BC/BS PROVIDER #
IL
Enumeration date
11/01/2006
Last updated
09/30/2008
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