Healthcare Provider Details

I. General information

NPI: 1417146689
Provider Name (Legal Business Name): CURTIS L SPEED MD HEALTH SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8058 S WESTERN AVE
CHICAGO IL
60620-5936
US

IV. Provider business mailing address

3601 W 183RD ST
HAZEL CREST IL
60429-2409
US

V. Phone/Fax

Practice location:
  • Phone: 773-863-9488
  • Fax:
Mailing address:
  • Phone: 708-957-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: CURTIS L SPEED
Title or Position: CEO
Credential: M.D.
Phone: 312-217-1450