Healthcare Provider Details

I. General information

NPI: 1972726701
Provider Name (Legal Business Name): CERMAK HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SOUTH CALIFORNIA AVENUE
CHICAGO IL
60608
US

IV. Provider business mailing address

950 WEST LAKE STREET
CHICAGO IL
60607-1718
US

V. Phone/Fax

Practice location:
  • Phone: 773-869-2954
  • Fax: 773-869-3578
Mailing address:
  • Phone: 773-869-2954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-001311
License Number StateIL

VIII. Authorized Official

Name: PROF. HARRY J. PRZEKOP JR.
Title or Position: PA-C PHYSICIST
Credential: PA-C PHYSICIST
Phone: 773-869-2954