Organization
TLC MEDICAL GROUP, S.C.
Active
Other names
TLC Women's Health S.C.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN SONG (MANAGING PHYSICIAN)
(630) 513-9160
Entity
Organization
Contact information
Practice address
40W222 LA FOX ROAD, SUITE J1, SAINT CHARLES, IL 60175
(630) 513-9160
(630) 513-9617
Mailing address
40W222 LA FOX ROAD, SUITE J1, SAINT CHARLES, IL 60175
(630) 513-9160
(630) 513-9617
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
03106052
IL
208000000X
Pediatrics Physician
036104024
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851452775
NPI NUMBER
IL
01
—
4532123
BLUECROSS BLUE SHIELD
IL
Enumeration date
12/04/2007
Last updated
01/14/2019
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