Organization
BETHANY HOMES AND METHODIST HOSPITAL
Active
Other names
Egel Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAMILLA LARSEN M.D. (MEDICAL DIRECTOR)
(773) 653-5630
Entity
Organization
Contact information
Practice address
5113 N CLARK ST, CHICAGO, IL 60640-2807
(773) 293-4090
(773) 293-4503
Mailing address
5113 N CLARK ST, CHICAGO, IL 60640-2807
(773) 293-4090
(773) 293-4503
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036108645
IL
Other
Enumeration date
12/06/2012
Last updated
12/20/2012
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