Organization
MAXICARE VISITING PHYSICIAN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NELSON MERCADO (OFFICE MANAGER)
(773) 961-7580
Entity
Organization
Contact information
Practice address
3300 W PETERSON AVE, SUITE H, CHICAGO, IL 60659
(773) 961-7580
Mailing address
3300 W PETERSON AVE STE H, CHICAGO, IL 60659-3585
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
07/18/2017
Last updated
07/18/2017
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