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Emergency Room Prior Authorization resume in Chicago, IL - March 2025

SMITH, TEDDY

Member ID: *********

Member Name:

RxBIN:

RxPCN:

RxGRP:

004336

ADV

RX0823

PCP Address:

PCP Phone:

**** * **** ** *** 101

,EVERGREEN PARK IL 60805

708-***-****

PCP: KHAN, MOHAMMED SHAEZOR

DOB:

Effective Date:

HealthChoice Illinois

04/17/1981

05/01/2024...


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