Graduated: 2013
NPI: 1528480381
Practice Locations (3)
PREMISE HEALTH OF ILLINOIS MEDICAL PC
6195 W 115TH ST, SUITE A
ALSIP, IL 608035153
3122627002
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER INC
4016 HOHMAN AVE
HAMMOND, IN 463271239
2199375808
SOUTHLAKE COMMUNITY MENTAL HEALTH CENTER INC
4022 HOHMAN AVE
HAMMOND, IN 463271239
2199373300
Source: CMS National Downloadable File, September 2026.