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General NPI Number Information
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NPI Number | 1407333685
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Entity Type | Organization
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Legal Business Name | 4D HEALTHWARE, LLC
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 401 N MICHIGAN AVE STE 1740
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City | CHICAGO
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State | IL
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Zip | 60611-4742
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Country | US
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Telephone | 224-633-9472
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Fax | 630-857-9069
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Provider Business Mailing Address
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Address Line | 401 N MICHIGAN AVE STE 1740
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City | CHICAGO
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State | IL
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Zip | 60611-4742
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Country | US
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Telephone | 224-633-9472
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Fax | 630-857-9069
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | STAR CUNNINGHAM
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Credential |
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Telephone | 847-650-7827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 036-094623
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License Number State | IL
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