MEDICARE: CHICAGO COMMUNITY CLINIC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RC0000X	Cardiovascular Disease Physician
2	208000000X	Pediatrics Physician
3	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1275395402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO COMMUNITY CLINIC

Provider Business Mailing Address
First Line	:	1606 LINDEN STREET
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 LINDEN STREET
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60018
Country	:	US
Telephone Number	:	773-973-3396
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	SAMEENA HUSSAIN
Credential	:
Telephone Number	:	630-234-0910

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	01/24/2024

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Directions to “CHICAGO COMMUNITY CLINIC ” Practice Location

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