Healthcare Provider Details

I. General information

NPI: 1932301439
Provider Name (Legal Business Name): CHICAGO FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 E 93RD ST FLOOR 1
CHICAGO IL
60617-3983
US

IV. Provider business mailing address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

V. Phone/Fax

Practice location:
  • Phone: 773-967-1135
  • Fax: 773-374-1621
Mailing address:
  • Phone: 773-768-5000
  • Fax: 773-374-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1769357
License Number StateIL

VIII. Authorized Official

Name: MRS. AMELIA RODRIGUEZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 773-768-5000