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Organization

DR. MENDENHALL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. DENISE SMITH (SENIOR BILLER/ EXEC. ASST.)
(331) 643-5238
Entity
Organization

Contact information

Practice address
8104 S KINGSTON AVE, CHICAGO, IL 60617-1231
(773) 434-6715
Mailing address
8104 S KINGSTON AVE, CHICAGO, IL 60617-1231
(773) 434-6715

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
180.007149
IL
251S00000X
Community/Behavioral Health Agency
21415
IL

Other

Enumeration date
12/14/2015
Last updated
12/14/2015
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