Healthcare Provider Details

I. General information

NPI: 1518379700
Provider Name (Legal Business Name): CHICAGOLAND COMPLETE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST STE 401
CHICAGO IL
60657-9268
US

IV. Provider business mailing address

3000 N HALSTED ST STE 401
CHICAGO IL
60657-9268
US

V. Phone/Fax

Practice location:
  • Phone: 773-935-5985
  • Fax: 773-935-5478
Mailing address:
  • Phone: 773-935-5985
  • Fax: 773-935-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036125989
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036125989
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number036125989
License Number StateIL

VIII. Authorized Official

Name: DR. BARRY SUMMERS
Title or Position: OWNER
Credential: MD
Phone: 708-529-0355