MEDICARE: CHICAGO REACH FOUNDATION

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1497747026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO REACH FOUNDATION

Provider Business Mailing Address
First Line	:	4501 W AUGUSTA BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3302
Country	:	US
Telephone Number	:	773-252-8989
Fax Number	:	773-252-8995

Provider Business Practice Location Address
First Line	:	4501 W AUGUSTA BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3302
Country	:	US
Telephone Number	:	773-252-8989
Fax Number	:	773-252-8995

Authorized Official
Title or Position	:	COO/RN/MS
Name	:	MRS. KAREN L GRICUS
Credential	:	RN
Telephone Number	:	773-252-8989

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/11/2025

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Directions to “CHICAGO REACH FOUNDATION ” Practice Location

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