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NPI Code Detail

MEDICARE: BAZELL CLINIC, LLC

MEDICARE: BAZELL CLINIC, 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
1207Q00000XFamily Medicine PhysicianIL
2208600000XSurgery PhysicianIL

General Provider Information

NPI Number : 1780616102
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAZELL CLINIC, LLC
Provider Business Mailing Address
First Line : 3520 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1317
Country : US
Telephone Number : 773-247-4900
Fax Number : 773-247-8145
Provider Business Practice Location Address
First Line : 3520 S ASHLAND AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60609-1317
Country : US
Telephone Number : 773-247-4900
Fax Number : 773-247-8145
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. YEUN HIE KIM
Credential :
Telephone Number : 312-738-3111
Provider Enumeration Date : 07/07/2006
Last Update Date : 09/11/2025

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Directions to “BAZELL CLINIC, LLC ” Practice Location

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