Healthcare Provider Details

I. General information

NPI: 1255560470
Provider Name (Legal Business Name): GREATER CHICAGO MEDICAL GROUP, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 S DANTE AVE
CHICAGO IL
60619-7118
US

IV. Provider business mailing address

PO BOX 68726
SCHAUMBURG IL
60168-0726
US

V. Phone/Fax

Practice location:
  • Phone: 773-221-3900
  • Fax: 847-352-0423
Mailing address:
  • Phone: 708-987-3795
  • Fax: 847-352-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RITA P SALDANHA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-987-3795