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General NPI Number Information
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NPI Number | 1841590163
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Entity Type | Organization
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Legal Business Name | CHICAGO EXPRESS DOCTORS, INC.
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 03/07/2012
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Provider Practice Location Address
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Address Line | 520 N KINGSBURY ST UNIT 3905
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City | CHICAGO
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State | IL
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Zip | 60654-8779
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Country | US
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Telephone | 312-929-4492
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Fax | 312-929-4493
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Provider Business Mailing Address
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Address Line | 520 N KINGSBURY ST # 3905
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City | CHICAGO
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State | IL
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Zip | 60654-8766
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Country | US
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Telephone | 312-929-4492
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Fax | 312-929-4493
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. TINA CASEY
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Credential |
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Telephone | 312-929-4492
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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 | 036078254
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License Number State | IL
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