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Specialty details in registry · Chicago, IL

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At a glance

5632 S. Emerald Ave, Chicago, IL 60621

NPPES record updated Nov 15, 2016. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

5632 S. Emerald Ave
Chicago, IL 60621

Professional details: NPI, taxonomy & registry record

NPI1063954519

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 343800000X
Enumeration date: Nov 15, 2016
Record updated: Nov 15, 2016

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

343800000X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

5632 S. Emerald Ave
Chicago, IL 60621

Phone: (708) 203-0343

Mailing address

5632 S EMERALD AVE

CHICAGO, IL 606212939

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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