| NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
| 1033531736 | FORD | WANISSA | 3752 W 16TH ST | CHICAGO | IL | 606232028 | ||
| 1457369662 | GILLARD | WILLIAM | H | 3752 W 16TH ST | CHICAGO | IL | 606232028 | |
| 1750874459 | PETERSEN | VALERIE | L | 3752 W 16TH ST | CHICAGO | IL | 606232028 |