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General NPI Number Information
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NPI Number | 1740463371
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Entity Type | Organization
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Legal Business Name | CHICAGOCARE LLC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 7240 W AZURE DR #165
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City | LAS VEGAS
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State | NV
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Zip | 89130-4405
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Country | US
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Telephone | 702-396-7689
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Fax | 702-645-9958
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Provider Business Mailing Address
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Address Line | 7240 W AZURE DR #165
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City | LAS VEGAS
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State | NV
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Zip | 89130-4405
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Country | US
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Telephone | 702-396-7689
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Fax | 702-645-9958
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. TERESA MARIE KARL
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Credential |
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Telephone | 702-396-7689
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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 | 1077
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License Number State | NV
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