MEDICARE: CHICAGO HAMLIN FAMILY PRACTICE SPECIALISTS LTD

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

General Provider Information

NPI Number	:	1326047788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO HAMLIN FAMILY PRACTICE SPECIALISTS LTD

Provider Business Mailing Address
First Line	:	520 E. 22ND STREET
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148
Country	:	US
Telephone Number	:	630-874-2542
Fax Number	:

Provider Business Practice Location Address
First Line	:	3758 W. CHICAGO AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651
Country	:	US
Telephone Number	:	773-235-0626
Fax Number	:

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	NOEL E. LASALA
Credential	:	M.D.
Telephone Number	:	773-235-0626

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/16/2007

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