Provider Demographics
NPI:1841945276
Name:PM CLINICAL NETWORK
Entity type:Organization
Organization Name:PM CLINICAL NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:312-623-1919
Mailing Address - Street 1:720 S WELLS ST APT 1615
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4793
Mailing Address - Country:US
Mailing Address - Phone:312-623-1919
Mailing Address - Fax:
Practice Address - Street 1:720 S WELLS ST APT 1615
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4793
Practice Address - Country:US
Practice Address - Phone:312-623-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare