MEDICARE: MICHIGAN AVE MEDICAL ASSOCIATES 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1366741456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN AVE MEDICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	845 N MICHIGAN AVE STE 910W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 N MICHIGAN AVE STE 930E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2213
Country	:	US
Telephone Number	:	312-202-0700
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	ROBERTO DIAZ
Credential	:
Telephone Number	:	312-521-5510

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

Similar Medicare Providers

1144393919 — DR. LESTER B. CHERNICK DDS
Practice Location Address:

845 N MICHIGAN AVE STE 921E
CHICAGO, IL
60611-2213

Practice Phone: 312-751-0026
Practice Fax: 312-751-0241

1073673323 — DR. JOSHUA ADAM RIES DMD
Practice Location Address:

845 N MICHIGAN AVE STE 921E
CHICAGO, IL
60611-2213

Practice Phone: 312-751-0026
Practice Fax: 312-751-0241

1588962609 — MR. ALEMAYEHU (ALEX) M GEBRESELLASSIE MLT
Practice Location Address:

845 N MICHIGAN AVE STE 944E
CHICAGO, IL
60611-2213

Practice Phone: 312-202-0328
Practice Fax: 312-202-0320

1346530201 — IMPALA EXPRESS CLINICAL LABORATORY SERVICE INC
Practice Location Address:

845 N MICHIGAN AVE STE 944E , 845 N. MICHIGAN AVE, SUITE # 944-E
CHICAGO, IL
60611-2213

Practice Phone: 312-202-0328
Practice Fax: 312-202-0320

1023135696 — CATHERINE ANN COFFEY CALLAHAN M.S., CCC-SLP
Practice Location Address:

655 W IRVING PARK RD , UNIT 2213
CHICAGO, IL
60613-3123

Practice Phone: 312-316-5650
Practice Fax:

1235350810 — MS. HEATHER MICHELLE TARASKIEWICZ MT
Practice Location Address:

2213 W. BELDEN AVE.
CHICAGO, IL
60647

Practice Phone: 773-519-1573
Practice Fax:

Directions to “MICHIGAN AVE MEDICAL ASSOCIATES LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.