Organization
NUTRIMEDICOS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY JENKINS (BILLING MANAGER)
(312) 953-0547
Entity
Organization
Contact information
Practice address
1719 W 18TH ST, CHICAGO, IL 60608-4833
(312) 929-2927
Mailing address
1719 W 18TH ST, CHICAGO, IL 60608-4833
(312) 929-2927
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
036117092
IL
Other
Enumeration date
04/03/2013
Last updated
04/03/2013
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