MEDICARE: INTEGRACARE

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	261Q00000X	Clinic/Center	036118945	IL

General Provider Information

NPI Number	:	1679842470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRACARE

Provider Business Mailing Address
First Line	:	2731 W POLK ST
Second Line	:	SUITE 2
City	:	CHICAGO
State	:	IL
Zip	:	60612-4033
Country	:	US
Telephone Number	:	773-722-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 E 87TH ST
Second Line	:	SUITE 107
City	:	CHICAGO
State	:	IL
Zip	:	60617-2713
Country	:	US
Telephone Number	:	773-734-3890
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. OTUONYE EZERIBE ONYEWUCHI
Credential	:	MD, MPH
Telephone Number	:	312-550-2586

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	12/27/2011

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Directions to “INTEGRACARE ” Practice Location

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