OrganizationActive
Cook County
NPI 1104946904 · Primary Care Clinic/Center · Cicero, IL
Provider details
- NPI number
- 1104946904
- Entity type
- Organization
- Primary specialty
- Primary Care Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- Cook County
- Authorized official
- Scott Andrle, Director of Managed Care Operations
- License
- 0005272 (IL)
Mailing address
1900 W Polk St Rm 220c
Chicago, IL 60612-3723
Registry dates
- Enumerated
- 2007-03-29
- Last updated
- 2019-02-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.