THE ILLINOIS MEDICAL ASSISTANCE TREATMENT PROGRAM LLC is a clinic center in Waukegan, IL. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). THE ILLINOIS MEDICAL ASSISTANCE TREATMENT PROGRAM LLC NPI is 1407008998. The provider is registered as an organization entity type.
The provider Other Name Is Green Dragonfly.
The provider's business location address is:
1738 WASHINGTON ST
WAUKEGAN, IL
ZIP 60085-137
Phone: (847) 360-1019
Fax: (847) 360-6277
The provider's authorized official is Richard L Keller .
The authorized official title is Medical Director and has the following contact phone number (847) 360-1019.
The enumeration date for this NPI number is 10/16/2008 and was last updated on 10/16/2008.