Organization
JRHMD MEDICAL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATRINA SMITH (ADMIN)
(855) 276-5212
Entity
Organization
Contact information
Practice address
6307 S STEWART AVE STE 203, CHICAGO, IL 60621-3116
(312) 504-8403
Mailing address
9335 S LEAVITT ST # 231, CHICAGO, IL 60643-6320
(855) 276-5212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036119430
—
IL
Enumeration date
07/13/2019
Last updated
02/15/2021
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