MEDICARE: CHICAGOLAND COMPLETE HEALTHCARE 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	207R00000X	Internal Medicine Physician	036125989	IL
2	207RS0010X	Sports Medicine (Internal Medicine) Physician	036125989	IL
3	207Q00000X	Family Medicine Physician	036125989	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518379700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGOLAND COMPLETE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3000 N HALSTED ST STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-9268
Country	:	US
Telephone Number	:	773-935-5985
Fax Number	:	773-935-5478

Provider Business Practice Location Address
First Line	:	3000 N HALSTED ST STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-9268
Country	:	US
Telephone Number	:	773-935-5985
Fax Number	:	773-935-5478

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BARRY SUMMERS
Credential	:	MD
Telephone Number	:	708-529-0355

Provider Enumeration Date	:	05/22/2014
Last Update Date	:	05/10/2018

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Directions to “CHICAGOLAND COMPLETE HEALTHCARE LLC ” Practice Location

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