Organization
CHICAGO COMMUNITY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PREM LATA PAUL MD (TREASURER)
(773) 978-5900
Entity
Organization
Contact information
Practice address
2404 EAST 79TH ST, CHICAGO, IL 60649-5112
(773) 978-5900
(773) 978-7656
Mailing address
155 HARBOR POINT #5212, CHICAGO, IL 60601-7381
(773) 978-5900
(773) 978-7656
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Enumeration date
07/29/2006
Last updated
08/22/2020
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