MEDICARE: ACE CLINICAL EXPERTS 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1326708694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACE CLINICAL EXPERTS LLC

Provider Business Mailing Address
First Line	:	1440 W TAYLOR ST # 1105
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4623
Country	:	US
Telephone Number	:	773-999-6071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 W LAKE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1908
Country	:	US
Telephone Number	:	773-999-6071
Fax Number	:

Authorized Official
Title or Position	:	LAB DIRECTOR
Name	:	TYIESHA WILSON
Credential	:
Telephone Number	:	773-999-6071

Provider Enumeration Date	:	12/28/2021
Last Update Date	:	12/28/2021

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