Organization
BROADWAY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
K.J. J PHILIP MD (OWNER)
(847) 475-6063
Entity
Organization
Contact information
Practice address
4826 N. BROADWAY, CHICAGO, IL 60640
(773) 275-8333
(773) 275-9297
Mailing address
4826 N BROADWAY ST, CHICAGO, IL 60640-3604
(773) 275-8333
(773) 275-9297
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
036110420
IL
Other
Enumeration date
08/21/2006
Last updated
04/13/2010
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