MEDICARE: NORTHWEST CHICAGO PRIMARY CARE SC

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	207R00000X	Internal Medicine Physician	036124775	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DT5494	OTHER	IL	RAILROAD MEDICARE PTAN

General Provider Information

NPI Number	:	1962760017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST CHICAGO PRIMARY CARE SC

Provider Business Mailing Address
First Line	:	2900 N 76TH CT
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-1101
Country	:	US
Telephone Number	:	773-635-5700
Fax Number	:	773-635-5050

Provider Business Practice Location Address
First Line	:	5641 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2742
Country	:	US
Telephone Number	:	773-635-5700
Fax Number	:	773-635-5050

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLEMAGNE G GUERRERO
Credential	:	M.D.
Telephone Number	:	773-504-0727

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	09/10/2013

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Directions to “NORTHWEST CHICAGO PRIMARY CARE SC ” Practice Location

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