MEDICARE: CITY 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	261QC1500X	Community Health Clinic/Center		IL

General Provider Information

NPI Number	:	1871595256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CHICAGO

Provider Business Mailing Address
First Line	:	333 S STATE ST
Second Line	:	REVENUE #200
City	:	CHICAGO
State	:	IL
Zip	:	60604-3900
Country	:	US
Telephone Number	:	312-747-9443
Fax Number	:	312-747-9447

Provider Business Practice Location Address
First Line	:	641 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2032
Country	:	US
Telephone Number	:	312-747-7831
Fax Number	:	312-747-0292

Authorized Official
Title or Position	:	FIRST DEPUTY COMMISSIONER
Name	:	MATTHEW W. BEAUDET
Credential	:
Telephone Number	:	312-747-9889

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/28/2010

Similar Medicare Providers

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Practice Location Address:

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1992794598 — MARC ROSENTHAL DDS
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1871711747 — DR. DAVID N MACLIN D.D.S.
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1316168412 — JENINE LEE CHILES PSY.D.
Practice Location Address:

641 W 63RD ST , SPECIALTY CLINIC, LOWER LEVEL
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1942499983 — MS. CAROLYN JEAN PAIGE NURSE PRACTITIONER
Practice Location Address:

641 W 63RD ST
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1912184664 — KINNARI N PATEL D.D.S
Practice Location Address:

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Directions to “CITY OF CHICAGO ” Practice Location

Language	Start Address	Practice Location

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