Provider Demographics
NPI:1982334843
Name:CORNERSTONE FAMILY HEALTH
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS THEVATHERIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-734-0580
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-0534
Mailing Address - Country:US
Mailing Address - Phone:630-734-0580
Mailing Address - Fax:
Practice Address - Street 1:3080 OGDEN AVE STE 204
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1694
Practice Address - Country:US
Practice Address - Phone:630-734-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty