MEDICARE: URBAN HEALTHCARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	036.124097	IL

General Provider Information

NPI Number	:	1144629460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN HEALTHCARE INC

Provider Business Mailing Address
First Line	:	1753 W CHICAGO AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60622-5009
Country	:	US
Telephone Number	:	773-672-2553
Fax Number	:	773-672-2559

Provider Business Practice Location Address
First Line	:	1753 W CHICAGO AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60622-5009
Country	:	US
Telephone Number	:	773-672-2553
Fax Number	:	773-672-2559

Authorized Official
Title or Position	:	OWNER
Name	:	KHUSHAL PATL
Credential	:	MD
Telephone Number	:	773-672-2553

Provider Enumeration Date	:	08/22/2014
Last Update Date	:	08/22/2014

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Directions to “URBAN HEALTHCARE INC ” Practice Location

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