Organization
MEDICINE & SURGERY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN J DOLEHIDE D.O. (OWNER)
(773) 779-7500
Entity
Organization
Contact information
Practice address
11250 S WESTERN AVE, CHICAGO, IL 60643-4116
(773) 779-7500
Mailing address
11250 S WESTERN AVE, CHICAGO, IL 60643-4116
(773) 779-7500
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036081654
IL
Other
Enumeration date
09/08/2011
Last updated
09/08/2011
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