MEDICARE: JOHN STRACKS, MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033780325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN STRACKS, MD, LLC

Provider Business Mailing Address
First Line	:	1828 W WEBSTER AVE STE 450
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2916
Country	:	US
Telephone Number	:	312-489-8890
Fax Number	:

Provider Business Practice Location Address
First Line	:	1828 W WEBSTER AVE STE 450
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2916
Country	:	US
Telephone Number	:	312-489-8890
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	NIRALI BHATT
Credential	:
Telephone Number	:	312-489-8890

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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