Mokena Family Physicians LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

036085722 Issued in IL

Legal business name

MOKENA FAMILY PHYSICIANS LLC

Practice address

11243 W la Porte Rd
Mokena, IL 60448-1374

Phone

(708) 479-4681

Fax

(708) 479-8516

NPI assigned

Nov 6, 2006

Last updated

Jun 25, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rhonda A Davis

Title

Manager

Phone

(708) 479-4681

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sarah Cupp, FNP

  • Family Nurse Practitioner
  • New Lenox, IL
  • NPI 1073167250
  NPD
• Christopher David Pagliarulo, PT

  • Physical Therapist
  • New Lenox, IL
  • NPI 1366610180
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372118400000",
    "number": "1740359876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11243 W LA PORTE RD",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604481374",
            "telephone_number": "708-479-4681",
            "fax_number": "708-479-8516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11243 W LA PORTE RD",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604481374",
            "telephone_number": "708-479-4681",
            "fax_number": "708-479-8516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOKENA FAMILY PHYSICIANS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2013-06-25",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "708-479-4681"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "036085722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036077425",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036085722",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Ann Miron
• Roseann Misheck, OTR/L
• Kari K Mizera, DPT
• Natalie Leona Mobley
• Adrienne Leigh Moeller, PT, DPT
• Mokena Fire Protection District
• Mokena Foot &Ankle Clinic
• Mokena Pharmacy Inc
• Mokena School District 159
• Jacob Morgenstern, M.D.

• Clinic/Center in Mokena, IL
• Providers in Mokena, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.