Organization
NORTHERN ILLINOIS EMERGENCY & OCCP MED SPEC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY GIACINTO M.D. (DIRECTOR)
(708) 460-7444
Entity
Organization
Contact information
Practice address
701 W NORTH AVE, MELROSE PARK, IL 60160-1612
(708) 681-3200
(708) 681-5228
Mailing address
33786 TREASURY CTR, CHICAGO, IL 60694-3700
(708) 460-7444
(708) 460-8662
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01623845
BLUE CROSS & BLUE SHEILD
IL
Enumeration date
11/07/2006
Last updated
08/22/2020
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