Organization
COMMUNITY MEDICAL CENTER OF DWIGHT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA MARIE CICHON (OFFICE MANAGER)
(815) 584-3051
Entity
Organization
Contact information
Practice address
103 S JOHN ST, DWIGHT, IL 60420-1413
(815) 584-3051
Mailing address
103 S JOHN ST, DWIGHT, IL 60420-1413
(815) 584-3051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036062435
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062435
—
IL
01
—
05315073
BLUE CROSS BLUE SHIELD
IL
Enumeration date
12/10/2009
Last updated
02/19/2010
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