MEDICARE: CHICAGO EXPRESS DOCTORS, INC.

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	036078254	IL

General Provider Information

NPI Number	:	1841590163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO EXPRESS DOCTORS, INC.

Provider Business Mailing Address
First Line	:	520 N KINGSBURY ST
Second Line	:	# 3905
City	:	CHICAGO
State	:	IL
Zip	:	60654-8766
Country	:	US
Telephone Number	:	312-929-4492
Fax Number	:	312-929-4493

Provider Business Practice Location Address
First Line	:	520 N KINGSBURY ST UNIT 3905
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-8779
Country	:	US
Telephone Number	:	312-929-4492
Fax Number	:	312-929-4493

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. TINA CASEY
Credential	:
Telephone Number	:	312-929-4492

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	03/07/2012

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