MEDICARE: CHRONIC CARE SOLUTIONS LLC

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	208D00000X	General Practice Physician
2	163WG0000X	General Practice Registered Nurse

General Provider Information

NPI Number	:	1679129977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRONIC CARE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	7331 N LINCOLN AVE STE 15
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-1766
Country	:	US
Telephone Number	:	847-983-8356
Fax Number	:	888-909-5815

Provider Business Practice Location Address
First Line	:	3050 W COLUMBIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4006
Country	:	US
Telephone Number	:	773-401-6275
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK MABAQUIAO
Credential	:
Telephone Number	:	773-401-6275

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	08/13/2019

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Directions to “CHRONIC CARE SOLUTIONS LLC ” Practice Location

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