| Organization Name: | MERRIONETTE PARK PHYSICIANS GROUP |
| NPI Number: | 1437186954 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY R COLTRO (PRESIDENT) |
| Mailing Address: | 9830 Ridgeland Ave Suite 7 Chicago Ridge |
| State: | IL US |
| Postal Code: | 604152667 |
| Phone Number: | 7084226800 |
| Fax Number: | 7084226888 |
| NPI Enumeration Date: | 06/28/2006 |
| NPI Last Update Date: | 01/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RR0500X |
| License Number: | 042617755 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Rheumatology |
| Taxonomy Definition: | An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |