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General NPI Number Information
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NPI Number | 1023065976
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Entity Type | Organization
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Legal Business Name | FAMILY CARE ASSOCIATES OF CHICAGO
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 6187 S ARCHER AVE SUITE 103
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City | CHICAGO
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State | IL
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Zip | 60638-2605
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Country | US
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Telephone | 773-581-1500
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Fax | 773-581-2160
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Provider Business Mailing Address
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Address Line | 6187 S ARCHER AVE SUITE 103
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City | CHICAGO
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State | IL
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Zip | 60638-2605
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Country | US
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Telephone | 773-581-1500
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Fax | 773-581-2160
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Authorized Official
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Title or Position | MEMBER
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Name | DR. CHARLES SHAW
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Credential | M.D.
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Telephone | 773-581-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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