MEDICARE: FAMILYDOC URGENT CARE 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1245880715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILYDOC URGENT CARE LLC

Provider Business Mailing Address
First Line	:	7201 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649
Country	:	US
Telephone Number	:	773-940-1612
Fax Number	:	630-559-7349

Provider Business Practice Location Address
First Line	:	7201 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649
Country	:	US
Telephone Number	:	773-940-1612
Fax Number	:	630-559-7349

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADEBAYO BADEMOSI
Credential	:	MD
Telephone Number	:	773-940-1612

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	06/01/2022

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