Healthcare Provider Details

I. General information

NPI: 1477458644
Provider Name (Legal Business Name): ACOSTA FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6021 WASHINGTON ST
GURNEE IL
60031-5356
US

IV. Provider business mailing address

12594 W MAWMAN AVE
BEACH PARK IL
60087-2027
US

V. Phone/Fax

Practice location:
  • Phone: 847-371-1615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAISY ACOSTA
Title or Position: FNP/OWNER
Credential: APRN
Phone: 847-371-1615