Cicero Medical Clinica San Lazaro LLC

NPI #1295822716 in Cicero, Illinois

Provider Information

NPI Number: 1295822716
Entity Type: Organization
Organization Name: Cicero Medical Clinica San Lazaro LLC
Primary Specialty: Family Medicine
Enumeration Date: Oct 6, 2006
Last Updated: Jul 16, 2009

Practice Location

Address: 5712 W 35TH ST
City: Cicero
State: Illinois
ZIP Code: 60804-4222
Phone: (708) 656-5485

Authorized Official

Name: MR. GERARD LICEA, MBA
Title: REGISTERED AGENT
Phone: (708) 656-5485

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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