Organization
PHYSICIANS COMMUNITY MEDICAL CENTER
Active
Parent organization
PHYSICIANS COOPERATIVE
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHYSICIANS COOPERATIVE
Authorized official
DR. GERALD J MINGOLELLI I M.D. (MEDICAL DIRECTOR)
(708) 535-6369
Entity
Organization
Contact information
Practice address
5320 W 159TH ST, STE 400, OAK FOREST, IL 60452-3334
(708) 798-8112
(708) 224-0365
Mailing address
5320 W 159TH ST, STE 400, OAK FOREST, IL 60452-3334
(708) 798-8112
(708) 224-0365
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
042-618622
IL
207R00000X
Internal Medicine Physician
042-618622
IL
207RG0100X
Gastroenterology Physician
Primary
042-618622
IL
207V00000X
Obstetrics & Gynecology Physician
042-618622
IL
208600000X
Surgery Physician
042-618622
IL
Other
Enumeration date
07/17/2006
Last updated
06/13/2013
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