Provider Demographics
NPI:1861750036
Name:D.O.C, FAMILY PRACTICE, S.C.
Entity type:Organization
Organization Name:D.O.C, FAMILY PRACTICE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PEOPLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-383-6333
Mailing Address - Street 1:PO BOX 2294
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60303-2294
Mailing Address - Country:US
Mailing Address - Phone:708-383-6333
Mailing Address - Fax:708-383-6347
Practice Address - Street 1:6300 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-2303
Practice Address - Country:US
Practice Address - Phone:708-383-6333
Practice Address - Fax:708-383-6347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075404261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1588775696OtherMEDICARE