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General NPI Number Information
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NPI Number | 1740391549
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Entity Type | Organization
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Legal Business Name | ROGERS PARK FAMILY MEDICINE, SC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 2306 W TOUHY AVE # C1
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City | CHICAGO
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State | IL
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Zip | 60645-3414
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Country | US
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Telephone | 773-262-7000
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Fax | 773-262-7002
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Provider Business Mailing Address
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Address Line | 2306 W TOUHY AVE STE C1
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City | CHICAGO
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State | IL
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Zip | 60645-3473
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Country | US
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Telephone | 773-262-7000
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Fax | 773-262-7002
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES P CLANCY
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Credential | MD
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Telephone | 773-262-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036096295
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License Number State | IL
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