EAR NOSE & THROAT SPECIALISTS OF ROCKFORD SC
Managed Care Organizations at Mulford Rd, Rockford, IL

License number
Illinois 036067207
Category
Managed Care Organizations
Type
Preferred Provider Organization
Owner
Name: DR. JAMES MELVIN SEVERSON III MD
Title: MEDICAL DOCTOR
Phone: (815) 399-5268
Address
Address
435 N Mulford Rd SUITE 10, Rockford, IL 61107
National Provider ID: 1740491745
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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EAR, NOSE & THROAT SPECIALISTS OF ROCKFORD, S.C

Rockford, IL 61102

Registration:
Sep 12, 1980
State ID:
52160812
Business type:
Domestic Bca
Expiration:
Perpetual
Agent:
James M Severson,435 N Mulford Rd, Rockford, IL 61107 (Physical)

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