MEDICARE: HEALTHCARE MANAGEMENT CONSULTING AND STAFFING OF CHICAGO

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	291U00000X	Clinical Medical Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14D2264781	OTHER	IL	CLIA

General Provider Information

NPI Number	:	1801523634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHCARE MANAGEMENT CONSULTING AND STAFFING OF CHICAGO

Provider Business Mailing Address
First Line	:	2648 W GLENLAKE AVE APT 3C
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2884
Country	:	US
Telephone Number	:	773-329-6545
Fax Number	:

Provider Business Practice Location Address
First Line	:	2535 W PETERSON AVE STE 526
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4019
Country	:	US
Telephone Number	:	773-329-6545
Fax Number	:

Authorized Official
Title or Position	:	LAB DIRECTOR/ PRESIDENT
Name	:	CESARIO BOLIGOR
Credential	:
Telephone Number	:	773-329-6545

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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