MEDICARE: FAMILYDOK URGENT CARE, 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1396595518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILYDOK URGENT CARE, LLC

Provider Business Mailing Address
First Line	:	7201 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2806
Country	:	US
Telephone Number	:	773-639-1335
Fax Number	:	773-940-1567

Provider Business Practice Location Address
First Line	:	7201 S STONY ISLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-2806
Country	:	US
Telephone Number	:	773-639-1335
Fax Number	:	773-940-1567

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	ADEBAYO BADEMOSI
Credential	:	MD
Telephone Number	:	773-639-1335

Provider Enumeration Date	:	03/22/2024
Last Update Date	:	03/22/2024

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