Organization
KIMBALL MEDICAL CENTER SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELY ROBERT TANDETER (OWNER)
(773) 235-6266
Entity
Organization
Contact information
Practice address
2837 N MILWAUKEE AVE, CHICAGO, IL 60618-7403
(773) 235-6266
Mailing address
2837 N MILWAUKEE AVE, CHICAGO, IL 60618-7403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
06/03/2006
Last updated
07/26/2013
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