Organization
DOLTON MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVANS FIAKPUI M.D. (MEDICAL DIRECTOR)
(708) 841-1110
Entity
Organization
Contact information
Practice address
15437 COTTAGE GROVE AVE, DOLTON, IL 60419-2742
(708) 841-1110
(708) 841-8730
Mailing address
15437 COTTAGE GROVE AVE, DOLTON, IL 60419-2742
(708) 841-1110
(708) 841-8730
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1634006
BCBSIL PROVIDER NUMBER
IL
Enumeration date
08/21/2006
Last updated
08/22/2020
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