# FAMILY DOCTOR MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FAMILY DOC, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1336516780
- **Legal business name:** FAMILY DOC, INC.
- **Authorized official:** JULIA JACKSON MA (OFFICE MANAGER)
- **Authorized official phone:** (773) 940-1612

## Contact information

- **Practice address:** 1918 W IRVING PARK RD, CHICAGO, IL 60613-2408
- **Practice address phone:** (773) 940-1612
- **Mailing address:** 1918 W IRVING PARK RD, CHICAGO, IL 60613-2408
- **Mailing address phone:** (773) 940-1612

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 036101658 | IL | Yes |

## Other

- **Enumeration date:** 09/01/2015
- **Last updated:** 09/01/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 20000890 | — | IL |