Healthcare Provider Details

I. General information

NPI: 1962356360
Provider Name (Legal Business Name): COMPLETE PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8074 N MILWAUKEE AVE
NILES IL
60714-2802
US

IV. Provider business mailing address

1402 W BUSSE AVE
MOUNT PROSPECT IL
60056-2975
US

V. Phone/Fax

Practice location:
  • Phone: 847-834-4101
  • Fax: 224-506-3403
Mailing address:
  • Phone: 847-834-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JESUS RENE DADIVAS JR.
Title or Position: OWNER
Credential: MD
Phone: 847-834-4101