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	261QM2500X	Medical Specialty Clinic/Center		IL

General Provider Information

NPI Number	:	1881968501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF CHICAGO

Provider Business Mailing Address
First Line	:	2861 NORTH CLARK STREET
Second Line	:	FLOOR 2
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	312-744-5507
Fax Number	:	312-744-9359

Provider Business Practice Location Address
First Line	:	2861 N CLARK ST
Second Line	:	FLOOR 2
City	:	CHICAGO
State	:	IL
Zip	:	60657-5207
Country	:	US
Telephone Number	:	312-744-5507
Fax Number	:	312-744-9359

Authorized Official
Title or Position	:	FIRST DEPUTY COMMISSIONER
Name	:	MR. ANTONIO BELTRAN
Credential	:
Telephone Number	:	312-747-9878

Provider Enumeration Date	:	02/27/2012
Last Update Date	:	02/27/2012

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Directions to “CITY OF CHICAGO ” Practice Location

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