MEDICARE: CHICAGOCARE 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	207Q00000X	Family Medicine Physician	1077	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	V101462	OTHER	NV	MEDICARE GROUP

General Provider Information

NPI Number	:	1740463371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGOCARE LLC

Provider Business Mailing Address
First Line	:	7240 W AZURE DR
Second Line	:	#165
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4405
Country	:	US
Telephone Number	:	702-396-7689
Fax Number	:	702-645-9958

Provider Business Practice Location Address
First Line	:	7240 W AZURE DR
Second Line	:	#165
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-4405
Country	:	US
Telephone Number	:	702-396-7689
Fax Number	:	702-645-9958

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. TERESA MARIE KARL
Credential	:
Telephone Number	:	702-396-7689

Provider Enumeration Date	:	12/05/2007
Last Update Date	:	12/05/2007

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Directions to “CHICAGOCARE LLC ” Practice Location

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