Healthcare Provider Details

I. General information

NPI: 1467669200
Provider Name (Legal Business Name): CHICAGO NORTH MEDICAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 N BROADWAY ST
CHICAGO IL
60640-2312
US

IV. Provider business mailing address

5308 N BROADWAY ST
CHICAGO IL
60640-2312
US

V. Phone/Fax

Practice location:
  • Phone: 773-784-2822
  • Fax: 773-784-3931
Mailing address:
  • Phone: 773-784-2822
  • Fax: 773-784-3931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036067628
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036047143
License Number StateIL

VIII. Authorized Official

Name: DR. MING S WU
Title or Position: SR. MANAGER
Credential: M.D.
Phone: 773-784-2822