Healthcare Provider Details

I. General information

NPI: 1497008981
Provider Name (Legal Business Name): M D TOTAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2012
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5318 W DEVON AVE
CHICAGO IL
60646-4108
US

IV. Provider business mailing address

5318 W DEVON AVE
CHICAGO IL
60646-4108
US

V. Phone/Fax

Practice location:
  • Phone: 847-731-9663
  • Fax: 847-731-9664
Mailing address:
  • Phone: 773-303-7711
  • Fax: 847-731-9664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MURRAY
Title or Position: PRESIDENT
Credential: MD
Phone: 847-731-9663