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NPI Code Detail

MEDICARE: CHICAGO MEG CENTER, LLC

MEDICARE: CHICAGO MEG CENTER, 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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1205012333
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO MEG CENTER, LLC
Provider Business Mailing Address
First Line : 11595 N MERIDIAN ST
Second Line : SUITE 300
City : CARMEL
State : IN
Zip : 46032-6947
Country : US
Telephone Number : 317-663-0384
Fax Number :
Provider Business Practice Location Address
First Line : 5554 S HYDE PARK BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1909
Country : US
Telephone Number : 773-324-9200
Fax Number : 773-324-9300
Authorized Official
Title or Position : VICE PRESIDENT
Name : MR. JOHN HAKES
Credential :
Telephone Number : 317-663-0384
Provider Enumeration Date : 01/18/2008
Last Update Date : 01/18/2008

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Directions to “CHICAGO MEG CENTER, LLC ” Practice Location

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