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General NPI Number Information
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NPI Number | 1407674104
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Entity Type | Organization
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Legal Business Name | ABSOLUTECARE OF ILLINOIS, PLLC
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 2627 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60608-3514
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Country | US
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Telephone | 667-400-0048
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Fax |
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Provider Business Mailing Address
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Address Line | 10175 LITTLE PATUXENT PKWY STE 800
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City | COLUMBIA
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State | MD
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Zip | 21044-3401
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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 | PRESIDENT
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Name | DR. GREGORY P. FOTI
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Credential | MD
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Telephone | 443-738-0225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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