MEDICARE: CHICAGO FAMILY HEALTH CENTER, 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	261QC1500X	Community Health Clinic/Center	149015413	IL

General Provider Information

NPI Number	:	1730436452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO FAMILY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	3963 W BELMONT AVE
Second Line	:	242
City	:	CHICAGO
State	:	IL
Zip	:	60618-5149
Country	:	US
Telephone Number	:	773-592-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	3963 W BELMONT AVE
Second Line	:	242
City	:	CHICAGO
State	:	IL
Zip	:	60618-5149
Country	:	US
Telephone Number	:	773-592-0696
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. ROBERT MAZIARKA
Credential	:
Telephone Number	:	773-768-5000

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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