Organization
LOYOLA MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADENRELE ADEKUNBI KOLAWOLE (DIRECTOR BILLING OPERATIONS)
(708) 216-3743
Entity
Organization
Contact information
Practice address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(708) 783-3125
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-8059
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
01/29/2018
Last updated
11/16/2020
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