Organization
ADVOCATE LUTHERAN GENERAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIOLA MJALTAJ M.D (RESIDENT)
(773) 704-6643
Entity
Organization
Contact information
Practice address
1775 DEMPSTER ST, PARK RIDGE, IL 60068-1143
(847) 723-7979
Mailing address
2127 N 72ND CT, ELMWOOD PARK, IL 60707-3104
(773) 704-6643
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
125.056297
IL
Other
Enumeration date
06/22/2009
Last updated
06/22/2009
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