Organization
KISHWAUKEE CORPORATE HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK G GANNON D.O. (MEDICAL DIRECTOR)
(815) 754-4882
Entity
Organization
Contact information
Practice address
3251 COMMERCE DR STE B, DEKALB, IL 60115-7908
(815) 754-4882
Mailing address
3251 COMMERCE DR STE B, DEKALB, IL 60115-7908
(815) 754-4882
Taxonomy
Speciality
Code
Description
License number
State
261QC1800X
Corporate Health Clinic/Center
Primary
036-077643
IL
Other
Enumeration date
07/07/2008
Last updated
07/07/2008
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