Organization
JEFFERSON PARK MEDICAL CENTER, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILROY EMMANUEL (INCORPORATOR)
(773) 736-3770
Entity
Organization
Contact information
Practice address
4955 N MILWAUKEE AVE STE 4, CHICAGO, IL 60630-2175
(773) 736-3770
(773) 736-1403
Mailing address
4955 N MILWAUKEE AVE STE 4, CHICAGO, IL 60630-2175
(773) 736-3770
(773) 736-1403
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
042.619228
IL
Other
Enumeration date
04/30/2008
Last updated
04/30/2008
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