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General NPI Number Information
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NPI Number | 1891345146
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Entity Type | Organization
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Legal Business Name | CARESTAFF DOCTORS LLC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 7301 N LINCOLN AVE STE 121
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1758
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Country | US
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Telephone | 224-470-2814
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Fax | 224-470-2815
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Provider Business Mailing Address
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Address Line | 7301 N LINCOLN AVE STE 121
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-1758
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Country | US
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Telephone | 224-470-2814
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Fax | 224-470-2815
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK MABAQUIAO
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Credential |
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Telephone | 224-470-2814
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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 |
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License Number State |
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