MEDICARE: CAL DEVON URGENT CARE INC

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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	243700	IL

General Provider Information

NPI Number	:	1528229861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAL DEVON URGENT CARE INC

Provider Business Mailing Address
First Line	:	6415 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6415 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5208
Country	:	US
Telephone Number	:	773-262-5400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIRZA BAIG
Credential	:
Telephone Number	:	773-262-5400

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	06/19/2008

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