Healthcare Provider Details

I. General information

NPI: 1205061124
Provider Name (Legal Business Name): MEXICARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W 26TH ST
CHICAGO IL
60623-4031
US

IV. Provider business mailing address

3200 W 26TH ST
CHICAGO IL
60623-4031
US

V. Phone/Fax

Practice location:
  • Phone: 773-890-1800
  • Fax: 773-890-1802
Mailing address:
  • Phone: 773-890-1800
  • Fax: 773-890-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054016687
License Number StateIL

VIII. Authorized Official

Name: JAWAD HAMDAN
Title or Position: PIC/OWNER
Credential: PHARMD
Phone: 708-336-9002