Organization
MPAC PHC OF IL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY MARTINEZ (CEO)
(888) 660-4425
Entity
Organization
Contact information
Practice address
200 N LA SALLE ST STE 1550, CHICAGO, IL 60601-1034
(888) 705-8722
Mailing address
PO BOX 5031 PMB 17336, EVANSTON, IL 60204-5031
(888) 705-8722
(888) 705-8722
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/29/2021
Last updated
12/10/2021
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