Healthcare Provider Details

I. General information

NPI: 1205177037
Provider Name (Legal Business Name): MIDTOWN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251A N CLYBOURN AVE
CHICAGO IL
60610
US

IV. Provider business mailing address

1251A N CLYBOURN AVE
CHICAGO IL
60610-1707
US

V. Phone/Fax

Practice location:
  • Phone: 312-498-0224
  • Fax:
Mailing address:
  • Phone: 312-498-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. TAMIKA N BURRUSS
Title or Position: OWNER/PRESIDENT
Credential: D.N.
Phone: 312-498-0224