Healthcare Provider Details

I. General information

NPI: 1801725312
Provider Name (Legal Business Name): CORE ID GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10849 KINGSTON ST
WESTCHESTER IL
60154-5018
US

IV. Provider business mailing address

10849 KINGSTON ST
WESTCHESTER IL
60154-5018
US

V. Phone/Fax

Practice location:
  • Phone: 312-479-0858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMMY MAJOGO
Title or Position: OWNER
Credential:
Phone: 312-479-0858