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General NPI Number Information
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NPI Number | 1619281482
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND FAMILY CARE LLC
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 09/06/2010
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Provider Practice Location Address
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Address Line | 5151 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2520
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Country | US
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Telephone | 773-334-6370
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Fax |
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Provider Business Mailing Address
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Address Line | 5151 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-2520
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Country | US
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Telephone | 773-334-6370
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NICOLA AZAR
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Credential | MD
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Telephone | 773-334-6370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036121756
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License Number State | IL
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