Organization
OCCU - SPORTS MED CORP
Active
Other names
Advanced Occupational Medicine Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
CASTOLINA SOLIS CPC (BILLING MANAGER)
(708) 493-0199
Entity
Organization
Contact information
Practice address
2615 HARRISON ST, BELLWOOD, IL 60104-2450
(708) 493-0199
(708) 493-9683
Mailing address
2615 HARRISON ST, BELLWOOD, IL 60104-2450
(708) 493-0199
(708) 493-9683
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036043379
IL
174400000X
Specialist
Primary
036078552
IL
174400000X
Specialist
036078648
IL
Other
Enumeration date
08/24/2005
Last updated
11/08/2010
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