is a Adult Medicine in Chicago, Illinois. practices all healthcare services and medical treatments related to Adult Medicine. The NPI Number for is 1619089174. The last update date is .
's current location address is 711 W North Ave, Chicago, Illinois. You can contact this provider via phone number 3122800996 and fax number 3122808789. The mailing address for is 711 W North Ave, Chicago, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 711 W North Ave, Chicago, Illinois |
| Phone Number | 3122800996 |
| Fax Number | 3122808789 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1619089174 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 711 W North Ave |
|---|---|
| City | Chicago |
| State | Illinois (IL) |
| Post Code | 606101174 |
| Phone Number | 3122800996 |
| Fax Number | 3122808789 |
Provider's Primary Taxonomy Detail
| Speciality | Adult Medicine |
|---|---|
| Taxonomy | 207Qa0505X |
| Licence No | 36064610 |
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Definition: The NUCC recommends this code not be used. Choose a more appropriate code. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 36064610 | IL | -- |
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