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NPI Code Detail

MEDICARE: COOK COUNTY

MEDICARE: COOK COUNTY
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
1261QP2300XPrimary Care Clinic/Center0001743IL

General Provider Information

NPI Number : 1760502439
Entity Type Code : Organization
Provider Name (Legal Business Name) : COOK COUNTY
Provider Business Mailing Address
First Line : 1900 W POLK ST RM 220C
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3723
Country : US
Telephone Number : 312-864-4649
Fax Number :
Provider Business Practice Location Address
First Line : 1645 COTTAGE GROVE AVE
Second Line :
City : FORD HEIGHTS
State : IL
Zip : 60411-3818
Country : US
Telephone Number : 708-753-5800
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF MANAGED CARE OPERATIONS
Name : SCOTT ANDRLE
Credential :
Telephone Number : 312-864-4649
Provider Enumeration Date : 03/29/2007
Last Update Date : 02/22/2019

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Directions to “COOK COUNTY ” Practice Location

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