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General NPI Number Information
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NPI Number | 1184189672
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Entity Type | Organization
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Legal Business Name | CALUMET COUNSELING AND DUI SERVICES,INC
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 1010 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60643-1522
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Country | US
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Telephone | 773-298-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 2 CARRINGTON CT
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City | HAZEL CREST
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State | IL
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Zip | 60429-2517
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Country | US
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Telephone | 708-341-6707
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Fax | 708-298-5723
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JAMES EDWARD BECKETT
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Credential | MD
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Telephone | 708-341-6707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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