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General NPI Number Information
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NPI Number | 1548447956
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Entity Type | Organization
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Legal Business Name | TOTAL CARE MEDICAL CLINIC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 04/13/2011
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Provider Practice Location Address
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Address Line | 6929 OGDEN AVE
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City | BERWYN
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State | IL
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Zip | 60402-3649
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Country | US
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Telephone | 708-484-9472
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Fax | 708-484-9473
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Provider Business Mailing Address
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Address Line | 6929 OGDEN AVE
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City | BERWYN
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State | IL
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Zip | 60402-3649
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Country | US
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Telephone | 708-484-9472
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Fax | 708-484-9473
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. LEONARD M SPISHAKOFF
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Credential | MD
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Telephone | 708-484-9506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 036091578
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License Number State | IL
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