Organization Name: | ADVOCATE CHRIST FAMILY MEDICINE CENTER |
NPI Number: | 1134364318 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DWAYNE BERNARD BUCHANAN (RESIDENT PHYSICIAN) |
Mailing Address: | 4140 Southwest Hwy Hometown |
State: | IL US |
Postal Code: | 604561135 |
Phone Number: | 7084225700 |
Fax Number: | |
NPI Enumeration Date: | 12/02/2008 |
NPI Last Update Date: | 12/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 125053019 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |