Healthcare Provider Details

I. General information

NPI: 1902009186
Provider Name (Legal Business Name): NAH EMERGENCY SERVICES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N FRANCISCO AVE
CHICAGO IL
60622-2743
US

IV. Provider business mailing address

1012 LAKE SHORE BLVD
EVANSTON IL
60202-1433
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: TUNJI LADIPO
Title or Position: PRESIDENT
Credential: MD
Phone: 773-292-5941