MEDICARE: LINCOLN PARK FAMILY PHYSICIANS SC

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		IL

General Provider Information

NPI Number	:	1760477863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN PARK FAMILY PHYSICIANS SC

Provider Business Mailing Address
First Line	:	1317 W DIVERSEY PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1207
Country	:	US
Telephone Number	:	773-665-9355
Fax Number	:	773-665-0403

Provider Business Practice Location Address
First Line	:	1317 W DIVERSEY PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1207
Country	:	US
Telephone Number	:	773-665-9355
Fax Number	:	773-665-0403

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN W TENHUNDFELD
Credential	:	M.D.
Telephone Number	:	773-665-9355

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/21/2022

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