Nova Physician Group PLLC
Clinic/Center, Primary Care in Chicago, IL. Organization (NPI-2).
NPI number1003662057
StatusActive
Last updated in NPPESApr 29, 2024
Details
- NPI
- 1003662057
- Entity type
- Organization (NPI-2)
- Legal business name
- Nova Physician Group PLLC
- Organization subpart
- No
- Enumeration date
- Apr 29, 2024
- Certification date
- Apr 29, 2024
- Last updated
- Apr 29, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
Practice location
1819 N Harlem AveChicago, IL 60707-3716
Phone 773-589-4385 · Fax 872-228-8601
Mailing address
30 W Monroe St Ste 1200Chicago, IL 60603-2420
Phone 773-352-1515 · Fax 312-929-0373
Authorized official
Terrence Morton
Sr. Medical Director
3127339730
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