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General NPI Number Information
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NPI Number | 1962760017
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Entity Type | Organization
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Legal Business Name | NORTHWEST CHICAGO PRIMARY CARE SC
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 5641 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60634-2742
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Country | US
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Telephone | 773-635-5700
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Fax | 773-635-5050
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Provider Business Mailing Address
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Address Line | 2900 N 76TH CT
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City | ELMWOOD PARK
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State | IL
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Zip | 60707-1101
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Country | US
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Telephone | 773-635-5700
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Fax | 773-635-5050
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLEMAGNE G GUERRERO
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Credential | M.D.
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Telephone | 773-504-0727
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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 | 036124775
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License Number State | IL
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