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NPI Code Detail

MEDICARE: ABSOLUTECARE OF ILLINOIS, PLLC

MEDICARE: ABSOLUTECARE OF ILLINOIS, PLLC
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
1251S00000XCommunity/Behavioral Health Agency
2261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1407674104
Entity Type Code : Organization
Provider Name (Legal Business Name) : ABSOLUTECARE OF ILLINOIS, PLLC
Provider Business Mailing Address
First Line : 10175 LITTLE PATUXENT PKWY STE 800
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-3401
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2627 W CERMAK RD
Second Line :
City : CHICAGO
State : IL
Zip : 60608-3514
Country : US
Telephone Number : 667-400-0048
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. GREGORY P. FOTI
Credential : MD
Telephone Number : 443-738-0225
Provider Enumeration Date : 10/01/2024
Last Update Date : 11/05/2024

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