MEDICARE: CORREA 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
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1275670192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORREA MEDICAL GROUP S.C.

Provider Business Mailing Address
First Line	:	1045 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3327
Country	:	US
Telephone Number	:	773-248-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3327
Country	:	US
Telephone Number	:	773-248-8644
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDUARDO CORREA
Credential	:	M.D.
Telephone Number	:	773-248-8644

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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