Healthcare Provider Details

I. General information

NPI: 1679129977
Provider Name (Legal Business Name): CHRONIC CARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 W COLUMBIA AVE
CHICAGO IL
60645-4006
US

IV. Provider business mailing address

7331 N LINCOLN AVE STE 15
LINCOLNWOOD IL
60712-1766
US

V. Phone/Fax

Practice location:
  • Phone: 773-401-6275
  • Fax:
Mailing address:
  • Phone: 847-983-8356
  • Fax: 888-909-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MARK MABAQUIAO
Title or Position: PRESIDENT
Credential:
Phone: 773-401-6275