MEDICARE: EQUINOX HEALTH CENTER

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	208D00000X	General Practice Physician	36108386	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36108386	OTHER	IL	MEDICAL LICENCE

General Provider Information

NPI Number	:	1295914497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUINOX HEALTH CENTER

Provider Business Mailing Address
First Line	:	5122 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5122 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2624
Country	:	US
Telephone Number	:	773-282-7952
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	GREG BIGAJ
Credential	:
Telephone Number	:	773-282-7952

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/24/2007

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Directions to “EQUINOX HEALTH CENTER ” Practice Location

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