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General NPI Number Information
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NPI Number | 1932429784
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Entity Type | Organization
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Legal Business Name | CHICAGO WEIGHT LOSS CLINIC, LLC
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 1 E SUPERIOR ST # 306
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City | CHICAGO
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State | IL
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Zip | 60611-2507
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Country | US
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Telephone | 312-565-1010
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Fax | 312-565-1212
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Provider Business Mailing Address
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Address Line | 155 N HARBOR DR # 5212
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City | CHICAGO
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State | IL
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Zip | 60601-7364
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Country | US
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Telephone | 312-565-1010
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Fax | 312-565-1212
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DHARAM PAUL
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Credential |
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Telephone | 312-565-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036044803
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License Number State | IL
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