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General NPI Number Information
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NPI Number | 1225372311
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND MEDICAL PC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 1 E DELAWARE PLACE SUITE 401B
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City | CHICAGO
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State | IL
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Zip | 60611-5135
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Country | US
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Telephone | 312-337-7968
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Fax | 312-337-4060
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Provider Business Mailing Address
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Address Line | 1 E DELAWARE PLACE SUITE 401B
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City | CHICAGO
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State | IL
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Zip | 60611-5135
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Country | US
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Telephone | 312-337-7968
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Fax | 312-337-4060
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHAEL N KAUF
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Credential | D.C.
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Telephone | 312-337-7968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038007889
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License Number State | IL
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