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General NPI Number Information
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NPI Number | 1932301439
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Entity Type | Organization
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Legal Business Name | CHICAGO FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 2320 E 93RD ST FLOOR 1
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City | CHICAGO
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State | IL
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Zip | 60617-3983
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Country | US
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Telephone | 773-967-1135
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Fax | 773-374-1621
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Provider Business Mailing Address
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Address Line | 9119 S EXCHANGE AVE
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City | CHICAGO
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State | IL
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Zip | 60617-4225
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Country | US
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Telephone | 773-768-5000
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Fax | 773-374-1621
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MRS. AMELIA RODRIGUEZ
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Credential |
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Telephone | 773-768-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 1769357
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License Number State | IL
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