MEDICARE: MICHIGAN AVENUE IMMEDIATE CARE

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	207Q00000X	Family Medicine Physician	042.616731	IL

General Provider Information

NPI Number	:	1174658694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN AVENUE IMMEDIATE CARE

Provider Business Mailing Address
First Line	:	180 N MICHIGAN AVE
Second Line	:	SUITE 1605
City	:	CHICAGO
State	:	IL
Zip	:	60601-7478
Country	:	US
Telephone Number	:	312-201-1234
Fax Number	:	312-201-1202

Provider Business Practice Location Address
First Line	:	180 N MICHIGAN AVE
Second Line	:	SUITE 1605
City	:	CHICAGO
State	:	IL
Zip	:	60601-7478
Country	:	US
Telephone Number	:	312-201-1234
Fax Number	:	312-201-1202

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JAMES A RUNKE
Credential	:	M.D.
Telephone Number	:	312-201-1234

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	11/01/2012

Similar Medicare Providers

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Practice Location Address:

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1407863210 — JAMES THOMAS BARRETT M.D.
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1952425035 — DR. JAMES A RUNKE M.D.
Practice Location Address:

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1801914106 — DR. NORMAN STANLEY LITOWITZ MD
Practice Location Address:

180 NORTH MICHIGAN AVENUE , SUITE 2220
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Practice Fax:

1902018732 — DR. BONNIE ELLENBOGEN LITOWITZ PHD
Practice Location Address:

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1013239672 — MICHIGAN AVENUE PRIMARY CARE, S.C.
Practice Location Address:

180 N MICHIGAN AVE , SUITE 1605
CHICAGO, IL
60601-7478

Practice Phone: 312-201-1234
Practice Fax: 312-201-1202

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