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General NPI Number Information
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NPI Number | 1265481030
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Entity Type | Organization
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Legal Business Name | EMERGENCY MEDICAL SPECIALIST, S.C
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 45 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-4200
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Country | US
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Telephone | 773-995-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 34816 EAGLE WAY
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City | CHICAGO
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State | IL
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Zip | 60678-1348
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Country | US
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Telephone | 630-734-0200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TUNJI LADIPO
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Credential | MD
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Telephone | 630-734-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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