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General NPI Number Information
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NPI Number | 1396900106
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Entity Type | Organization
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Legal Business Name | GREATER CHICAGO MEDICAL ASSOCIATION, INC
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 4108 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3028
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Country | US
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Telephone | 773-271-5000
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Fax | 773-784-6700
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Provider Business Mailing Address
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Address Line | 4108 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3028
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Country | US
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Telephone | 773-271-5000
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Fax | 773-784-6700
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDER JORDAN ZUREIKAT
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Credential | M.D.
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Telephone | 773-271-5000
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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 |
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License Number State |
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