Organization
CHICAGO MONTICELLO MEDICAL CTR
Active
Other names
MICHAEL W EARLY MD
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL EARLEY (MD)
(773) 722-6171
Entity
Organization
Contact information
Practice address
3623 W CHICAGO AVE, CHICAGO, IL 60651-3934
(773) 722-6171
(773) 722-7913
Mailing address
3623 W CHICAGO AVE, CHICAGO, IL 60651-3934
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1478723
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/30/2006
Last updated
11/19/2007
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