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General NPI Number Information
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NPI Number | 1972726701
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Entity Type | Organization
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Legal Business Name | CERMAK HEALTH SERVICES
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 2800 SOUTH CALIFORNIA AVENUE
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City | CHICAGO
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State | IL
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Zip | 60608
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Country | US
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Telephone | 773-869-2954
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Fax | 773-869-3578
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Provider Business Mailing Address
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Address Line | 950 WEST LAKE STREET
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City | CHICAGO
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State | IL
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Zip | 60607-1718
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Country | US
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Telephone | 773-869-2954
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Fax |
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Authorized Official
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Title or Position | PA-C PHYSICIST
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Name | PROF. HARRY J. PRZEKOP JR.
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Credential | PA-C PHYSICIST
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Telephone | 773-869-2954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-001311
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License Number State | IL
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