Provider Demographics
NPI:1437350881
Name:YOUR DOC OF MELROSE PARK
Entity Type:Organization
Organization Name:YOUR DOC OF MELROSE PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLOWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-839-8800
Mailing Address - Street 1:PO BOX 95748
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-0748
Mailing Address - Country:US
Mailing Address - Phone:847-839-8800
Mailing Address - Fax:847-839-8808
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 306
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-450-0055
Practice Address - Fax:708-450-0288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty