Healthcare Provider Details

I. General information

NPI: 1427963016
Provider Name (Legal Business Name): CHICAGO MEDIVAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4631 W 87TH PL APT 2
HOMETOWN IL
60456-2230
US

IV. Provider business mailing address

4631 W 87TH PL APT 2
HOMETOWN IL
60456-2230
US

V. Phone/Fax

Practice location:
  • Phone: 773-554-6503
  • Fax:
Mailing address:
  • Phone: 773-554-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JIBRIEL I TAWALBEH
Title or Position: CEO
Credential:
Phone: 773-554-6503