Organization
SUPREME MD INC.
Active
Other names
Supreme MD
Organization subpart
No
Provider details
NPI number
Authorized official
CESARIO BOLIGOR (CEO)
(773) 329-6545
Entity
Organization
Contact information
Practice address
5737 N TALMAN AVE APT 2, CHICAGO, IL 60659-5097
(773) 329-6545
Mailing address
5737 N TALMAN AVE APT 2, CHICAGO, IL 60659-5097
(773) 329-6545
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
251F00000X
Home Infusion Agency
—
—
Other
Enumeration date
01/20/2021
Last updated
01/20/2021
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