Provider Demographics
NPI:1720277122
Name:VILLAGE OF OAK PARK, DEPT. OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:VILLAGE OF OAK PARK, DEPT. OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:PROVOST-FYFE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:708-358-5492
Mailing Address - Street 1:123 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-4205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4205
Practice Address - Country:US
Practice Address - Phone:708-358-5492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL386130Medicare PIN