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1699751156
ELLEN M HENNECKE
EVERGREEN PARK, IL
NPI
1699751156
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: IL 036083750)
Enumeration Date
2005-12-16
Last Update Date
2007-07-08
Business Address
-- ELLEN M HENNECKE DO
3927 W 95TH ST
EVERGREEN PARK, IL 60805-1903
Phone number: 708-952-4566
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Mailing Address
-- ELLEN M HENNECKE DO
18141 DIXIE HWY STE 107
HOMEWOOD, IL 60430-2238
Phone number: 708-799-8440
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