Organization
ADVOCATE ILLINOIS MASONIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN COTTO (RESIDENCY COORDINATOR)
(773) 296-8250
Entity
Organization
Contact information
Practice address
836 W WELLINGTON AVE, FAMILY PRACTICE, CHICAGO, IL 60657-5147
(773) 296-8250
Mailing address
3430 N ELAINE PL, APT 4, CHICAGO, IL 60657-2483
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/21/2008
Last updated
05/21/2008
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