MEDICARE: CHICAGO DEPARTMENT OF PUBLIC HEALTH

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	261QC1500X	Community Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659697969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO DEPARTMENT OF PUBLIC HEALTH

Provider Business Mailing Address
First Line	:	333 S STATE ST
Second Line	:	ROOM 200 - REVENUE
City	:	CHICAGO
State	:	IL
Zip	:	60604-3900
Country	:	US
Telephone Number	:	312-747-9545
Fax Number	:	312-745-7603

Provider Business Practice Location Address
First Line	:	1713 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2014
Country	:	US
Telephone Number	:	312-746-5157
Fax Number	:

Authorized Official
Title or Position	:	FIRST DEPUTY COMMISSIONER
Name	:	MATTHEW W BEAUDET
Credential	:
Telephone Number	:	312-747-9889

Provider Enumeration Date	:	04/12/2010
Last Update Date	:	04/12/2010

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Directions to “CHICAGO DEPARTMENT OF PUBLIC HEALTH ” Practice Location

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