Provider Demographics
NPI:1497213110
Name:SOLLEY'S MEDICAL GROUP
Entity Type:Organization
Organization Name:SOLLEY'S MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRETT
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:708-529-0188
Mailing Address - Street 1:4239 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2623
Mailing Address - Country:US
Mailing Address - Phone:708-529-0188
Mailing Address - Fax:
Practice Address - Street 1:4239 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2623
Practice Address - Country:US
Practice Address - Phone:708-529-0188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty