Healthcare Provider Details

I. General information

NPI: 1609234202
Provider Name (Legal Business Name): OAK STREET PHYSICIAN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N RACINE AVE 100
CHICAGO IL
60607-1644
US

IV. Provider business mailing address

213 N RACINE AVE 100
CHICAGO IL
60607-1644
US

V. Phone/Fax

Practice location:
  • Phone: 312-733-9730
  • Fax:
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GRIFFIN MYERS
Title or Position: PRESIDENT, CHIEF MEDICAL OFFICER
Credential: MD
Phone: 312-600-8484