Basic Information
Provider Information
NPI: 1205005691
EntityType: 2
ReplacementNPI:  
OrganizationName: HYGEIA MEDICAL GROUP SC
LastName:  
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Mailing Information
Address1: 10660 W 143RD ST
Address2: SUITE B
City: ORLAND PARK
State: IL
PostalCode: 604621982
CountryCode: US
TelephoneNumber: 7084604499
FaxNumber: 7084608031
Practice Location
Address1: 12211 S HARLEM AVE
Address2:  
City: PALOS HEIGHTS
State: IL
PostalCode: 604631471
CountryCode: US
TelephoneNumber: 7083614211
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/29/2008
LastUpdateDate: 05/15/2008
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: CHRONIS
AuthorizedOfficialFirstName: GEORGE
AuthorizedOfficialMiddleName: BASIL
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 7083614211
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 

ID Information
IDTypeStateIssuerDescription
CF120401ILPALMETTO RR MEDICAREOTHER


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