Cook County
Family Medicine in Chicago, IL. Organization (NPI-2).
NPI number1194356089
StatusActive
Last updated in NPPESMar 2, 2020
Details
- NPI
- 1194356089
- Entity type
- Organization (NPI-2)
- Legal business name
- Cook County
- Organization subpart
- Yes
- Enumeration date
- Jan 29, 2020
- Certification date
- Mar 2, 2020
- Last updated
- Mar 2, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Other names
- Near South Health Center (Ffs) (Doing Business As)
Practice location
3525 S Michigan AveChicago, IL 60653-1019
Phone 312-945-4010
Mailing address
1900 W Polk St Rm 220cChicago, IL 60612-3723
Authorized official
Scott Andrle
Director Of Managed Care Operations
3128644649
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