Healthcare Provider Details

I. General information

NPI: 1184189672
Provider Name (Legal Business Name): CALUMET COUNSELING AND DUI SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W 95TH ST
CHICAGO IL
60643-1522
US

IV. Provider business mailing address

2 CARRINGTON CT
HAZEL CREST IL
60429-2517
US

V. Phone/Fax

Practice location:
  • Phone: 773-298-1177
  • Fax:
Mailing address:
  • Phone: 708-341-6707
  • Fax: 708-298-5723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES EDWARD BECKETT
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 708-341-6707