Organization
KISHWAUKEE CORPORATE HEALTH @MOI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK G GANNON DO (PHYSICIAN)
(815) 754-4882
Entity
Organization
Contact information
Practice address
2111 MIDLANDS CT, SUITE 201, SYCAMORE, IL 60178-3125
(181) 575-4488
Mailing address
2111 MIDLANDS CT, SUITE 201, SYCAMORE, IL 60178
(181) 575-4488
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
036-077643
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255594545
WORKER'S COMP
IL
Enumeration date
01/22/2015
Last updated
01/22/2015
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