Organization
TLC MEDICAL GROUP, S.C.
Active
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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