Healthcare Provider Details

I. General information

NPI: 1578977328
Provider Name (Legal Business Name): OPTIONS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 S WABASH AVE SUITE 250
CHICAGO IL
60605-2346
US

IV. Provider business mailing address

1147 S WABASH AVE SUITE 250
CHICAGO IL
60605-2346
US

V. Phone/Fax

Practice location:
  • Phone: 312-360-1604
  • Fax:
Mailing address:
  • Phone: 312-360-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209011079
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012545
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036127953
License Number StateIL

VIII. Authorized Official

Name: MATTHEW WALKER
Title or Position: MANAGER
Credential:
Phone: 312-360-1604