Healthcare Provider Details

I. General information

NPI: 1114602760
Provider Name (Legal Business Name): INTUITIVE EXPRESSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W OGDEN AVE
CHICAGO IL
60623-2821
US

IV. Provider business mailing address

4100 W OGDEN AVE
CHICAGO IL
60623-2821
US

V. Phone/Fax

Practice location:
  • Phone: 312-405-8536
  • Fax:
Mailing address:
  • Phone: 312-405-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: UMEKO JONES
Title or Position: VP
Credential: FNP
Phone: 312-405-8536