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NPI Code Detail

MEDICARE: GREATER CHICAGO MEDICAL GROUP, S.C.

MEDICARE: GREATER CHICAGO MEDICAL GROUP, S.C.
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
1103TP2701XGroup Psychotherapy Psychologist
2207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
164612247OTHERILCORPORATE FILE NUMBER

General Provider Information

NPI Number : 1255560470
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREATER CHICAGO MEDICAL GROUP, S.C.
Provider Business Mailing Address
First Line : PO BOX 68726
Second Line :
City : SCHAUMBURG
State : IL
Zip : 60168-0726
Country : US
Telephone Number : 708-987-3795
Fax Number : 847-352-0423
Provider Business Practice Location Address
First Line : 8700 S DANTE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60619-7118
Country : US
Telephone Number : 773-221-3900
Fax Number : 847-352-0423
Authorized Official
Title or Position : PRESIDENT
Name : DR. RITA P SALDANHA
Credential : M.D.
Telephone Number : 708-987-3795
Provider Enumeration Date : 07/09/2009
Last Update Date : 10/10/2018

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