MEDICARE: FAMILY DOC S.C.

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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1740481878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DOC S.C.

Provider Business Mailing Address
First Line	:	2500 W HIGGINS RD
Second Line	:	SUITE 620
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60195-5220
Country	:	US
Telephone Number	:	847-839-8800
Fax Number	:	847-839-8808

Provider Business Practice Location Address
First Line	:	6033 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2521
Country	:	US
Telephone Number	:	773-777-4767
Fax Number	:	773-777-0328

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. STEVE HOLOWICKI
Credential	:
Telephone Number	:	847-839-8800

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	08/22/2020

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