Organization
FAMILY CARE ASSOCIATES OF CHICAGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES SHAW M.D. (MEMBER)
(773) 581-1500
Entity
Organization
Contact information
Practice address
6187 S ARCHER AVE, SUITE 103, CHICAGO, IL 60638-2605
(773) 581-1500
(773) 581-2160
Mailing address
6187 S ARCHER AVE, SUITE 103, CHICAGO, IL 60638-2605
(773) 581-1500
(773) 581-2160
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1618283
BLUE CROSS BLUE SHIELD #
IL
01
—
CL4550
RAILROAD GROUP #
IL
Enumeration date
05/27/2006
Last updated
07/21/2016
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