Cook County
Organization Active NPI Geriatric Medicine (Family Medicine) Physician · Blue Island, IL
NPI 1780205708 · NPPES record last updated Apr 30, 2020
Key facts
- NPI
- 1780205708
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Geriatric Medicine (Family Medicine) Physician 207QG0300X
- Legal business name
- COOK COUNTY
- Practice address
- 12757 S. Western Ave
Blue Island, IL 60406 - Phone
- (708) 293-8400
- NPI assigned
- Apr 30, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- COOK COUNTY
Authorized official
- Name
- Scott Andrle
- Title
- Director of Managed Care
- Phone
- (312) 864-4649
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Community Triage Center
- Part of
- Community Triage Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician |
207QG0300X | Yes |
Addresses
Primary practice location
12757 S. Western Ave
Blue Island, IL 60406
Mailing address
1900 W Polk St Ste 220C
Chicago, IL 60612-3723
Other names
- Cook County Health at Blue Island
Other providers in Blue Island, IL
- Randi Coley
- Jeanine Connolly
- Cook County
- Cook County
- Cook County
- Cook County School Dist 130
- Kesi Alyce Cook
- Judith A Corcoran
- Amada Lucia Cordova
- Core Inc.
All providers in Blue Island, IL · Geriatric Medicine (Family Medicine) Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.