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General NPI Number Information
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NPI Number | 1275395402
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Entity Type | Organization
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Legal Business Name | CHICAGO COMMUNITY CLINIC
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Dates
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Enumeration Date | 01/24/2024
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 1606 LINDEN STREET
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City | DES PLAINES
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State | IL
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Zip | 60018
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Country | US
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Telephone | 773-973-3396
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 LINDEN STREET
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City | DES PLAINES
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State | IL
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Zip | 60018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SAMEENA HUSSAIN
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Credential |
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Telephone | 630-234-0910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease 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 | 208000000X
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Taxonomy Name | Pediatrics 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 | 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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