Organization
MACENTEE KNOX & VARGAS MDS
Active
Other names
SOUTHCARE FAMILY PRACTICE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER F MACENTEE M.D. (PRESIDENT)
(773) 779-9300
Entity
Organization
Contact information
Practice address
10627 S PULASKI RD, CHICAGO, IL 60655-3827
(773) 779-9300
(773) 779-5768
Mailing address
10627 S PULASKI RD, CHICAGO, IL 60655-3827
(773) 779-9300
(773) 779-5768
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
036047977
IL
305R00000X
Preferred Provider Organization
Primary
036072512
IL
305S00000X
Point of Service
036063080
IL
Other
Enumeration date
09/21/2007
Last updated
03/08/2011
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