Provider Demographics
NPI:1942476957
Name:HEALTH MAINTENANCE INSITITUE OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:HEALTH MAINTENANCE INSITITUE OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KYE
Authorized Official - Suffix:
Authorized Official - Credentials:CHES
Authorized Official - Phone:847-635-6580
Mailing Address - Street 1:2604 E DEMPSTER ST STE 402
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8438
Mailing Address - Country:US
Mailing Address - Phone:847-635-6580
Mailing Address - Fax:847-635-0038
Practice Address - Street 1:2604 E DEMPSTER ST STE 402
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8438
Practice Address - Country:US
Practice Address - Phone:847-635-6580
Practice Address - Fax:847-635-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044591172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty