Provider Demographics
NPI:1669635223
Name:FRANKFORT MEDICAL CLINIC
Entity Type:Organization
Organization Name:FRANKFORT MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIAYONA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-756-3988
Mailing Address - Street 1:1480 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 W 203RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1184
Practice Address - Country:US
Practice Address - Phone:815-464-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANKFORT MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-03
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL63103449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103449Medicaid
IL210718Medicare PIN
IL110224351Medicare PIN
IL036103449Medicaid