Healthcare Provider Details

I. General information

NPI: 1104066398
Provider Name (Legal Business Name): CENTRAL MEDICAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 N CENTRAL AVE
CHICAGO IL
60639-1351
US

IV. Provider business mailing address

2715 N CENTRAL AVE
CHICAGO IL
60639-1351
US

V. Phone/Fax

Practice location:
  • Phone: 312-326-6100
  • Fax: 773-385-6890
Mailing address:
  • Phone: 312-326-6100
  • Fax: 773-385-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN J OKEEFE
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 312-326-6100