Provider Demographics
NPI:1457662116
Name:HERME O SYLORA MD PC
Entity Type:Organization
Organization Name:HERME O SYLORA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SYLORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-469-9392
Mailing Address - Street 1:21020 S 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9186
Mailing Address - Country:US
Mailing Address - Phone:815-469-9392
Mailing Address - Fax:815-469-0616
Practice Address - Street 1:21020 S 80TH AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9186
Practice Address - Country:US
Practice Address - Phone:815-469-9392
Practice Address - Fax:815-469-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-046363261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL764560Medicare PIN
ILC41768Medicare UPIN