Organization
SOUTH LAKE MEDICAL SERVICES, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA C THACHENKERY M.D (PRESIDENT)
(773) 375-1900
Entity
Organization
Contact information
Practice address
2621 E 75TH ST, CHICAGO, IL 60649-3705
(773) 375-1900
(773) 375-8279
Mailing address
2621 E 75TH ST, CHICAGO, IL 60649-3705
(773) 375-1900
(773) 375-8279
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
036049708
IL
Other
Enumeration date
05/14/2008
Last updated
05/14/2008
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