1518237528 NPI number — AFG GUIDANCE CENTER KENILWORTH, INC.

Table of content: DR. MICHELE TROUTMAN GIFFORD MD (NPI 1003307794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518237528 NPI number — AFG GUIDANCE CENTER KENILWORTH, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFG GUIDANCE CENTER KENILWORTH, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518237528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
444 GREEN BAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENILWORTH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60043-1001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-853-0234
Provider Business Mailing Address Fax Number:
847-853-0230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 GREEN BAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENILWORTH
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60043-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-853-0234
Provider Business Practice Location Address Fax Number:
847-853-0230
Provider Enumeration Date:
01/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FALKOWSKA-GROSRENAUD
Authorized Official First Name:
ALFREDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-510-5013

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  036092952 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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