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General NPI Number Information
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NPI Number | 1467669200
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Entity Type | Organization
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Legal Business Name | CHICAGO NORTH MEDICAL PARTNERSHIP
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 5308 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60640-2312
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Country | US
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Telephone | 773-784-2822
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Fax | 773-784-3931
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Provider Business Mailing Address
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Address Line | 5308 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60640-2312
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Country | US
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Telephone | 773-784-2822
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Fax | 773-784-3931
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Authorized Official
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Title or Position | SR. MANAGER
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Name | DR. MING S WU
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Credential | M.D.
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Telephone | 773-784-2822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 036067628
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 036047143
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License Number State | IL
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