Healthcare Provider Details

I. General information

NPI: 1184636516
Provider Name (Legal Business Name): CIRCLE MEDICAL MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 W WASHINGTON BLVD
CHICAGO IL
60607-1821
US

IV. Provider business mailing address

1426 W WASHINGTON BLVD
CHICAGO IL
60607-1821
US

V. Phone/Fax

Practice location:
  • Phone: 312-829-1424
  • Fax: 312-850-8431
Mailing address:
  • Phone: 312-829-1424
  • Fax: 312-850-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number36061118
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number36061118
License Number StateIL

VIII. Authorized Official

Name: MRS. KIMBERLY CHEW
Title or Position: BILLING SUPERSIVOR
Credential:
Phone: 312-829-1424