Organization
FAMILY HEALTH CENTER PHYSICIANS, LET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME T DALY DO (PRESIDENT)
(708) 331-9200
Entity
Organization
Contact information
Practice address
17060 S PARK AVE, SOUTH HOLLAND, IL 60473-3349
(708) 331-9200
(708) 331-5519
Mailing address
17060 S PARK AVE, SOUTH HOLLAND, IL 60473-3349
(708) 331-9200
(708) 331-5519
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09932131
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/23/2007
Last updated
08/22/2020
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