Healthcare Provider Details

I. General information

NPI: 1720776321
Provider Name (Legal Business Name): AMERICAN INDIAN HEALTH SERVICE OF CHICAGO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 W MONTROSE AVE
CHICAGO IL
60641-2016
US

IV. Provider business mailing address

4326 W MONTROSE AVE
CHICAGO IL
60641-2016
US

V. Phone/Fax

Practice location:
  • Phone: 773-883-9100
  • Fax: 773-883-0005
Mailing address:
  • Phone: 773-883-9100
  • Fax: 773-883-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SHARON HOLT
Title or Position: QAQI/RISK MANAGMENT
Credential:
Phone: 773-883-9100