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General NPI Number Information
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NPI Number | 1255606778
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Entity Type | Organization
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Legal Business Name | CAMMI, LLC
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 1840 OAK AVE SUITE 125
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City | EVANSTON
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State | IL
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Zip | 60201-3642
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Country | US
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Telephone | 773-649-4154
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Fax | 773-453-3202
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Provider Business Mailing Address
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Address Line | 1840 OAK AVE SUITE 125
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City | EVANSTON
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State | IL
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Zip | 60201-3642
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Country | US
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Telephone | 773-649-4154
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Fax | 773-453-3202
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | MARK ROSENBLOOM
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Credential | MD, MBA, FAAEM
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Telephone | 773-649-4154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 036.085053
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License Number State | IL
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