Broadway Medical Group

NPI 1306952858 - Legal Medicine - 173000000X

NPI Details
NPI 1306952858
Enumeration Date 08/21/2006
Last Updated 04/13/2010
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name K.J. J K.J.
Position OWNER
Phone (773) 275-8333
Fax (773) 275-9297
Practice Location
4826 N. BROADWAY
CHICAGO IL, 60640, US
Phone (773) 275-8333
Fax (773) 275-9297
Business Location
4826 N BROADWAY ST
CHICAGO IL, 60640-3604, US
Phone (773) 275-8333
Fax (773) 275-9297
Toxanomy
Taxonomy Code 173000000X
License State Illinois
License Number 036110420
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According to our database, Broadway Medical Group NPI is 1306952858, taxonomy code is 173000000X and license number is 036110420, license state is located at Illinois. Broadway Medical Group physically located at 4826 N. Broadway, Chicago IL, 60640. NPI Number 1033115704 has the healthcare provider type.

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1306952858 NPI number is provided on an as is basis without warranty of any kind. 1306952858 is maintained by the National Plan & Provider Enumeration System. The contents of Broadway Medical Group are for informational purposes only.