Organization
HEALTH DEPARTMENT
Active
Other names
St Bernard Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PRATHIBHA V THARIMALA MD (PEDIATRICIAN)
(773) 667-4631
Entity
Organization
Contact information
Practice address
5400 S HYDE PARK BLVD APT D2, CHICAGO, IL 60615-5852
(773) 667-4631
Mailing address
5400 S HYDE PARK BLVD APT D2, CHICAGO, IL 60615-5852
(773) 667-4631
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
036048048
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
U45703
—
IL
Enumeration date
05/29/2008
Last updated
05/29/2008
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