Organization
FAMILY DOCTOR MEDICAL CENTER
Active
Parent organization
FAMILY DOC, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY DOC, INC.
Authorized official
JULIA JACKSON MA (OFFICE MANAGER)
(773) 940-1612
Entity
Organization
Contact information
Practice address
1918 W IRVING PARK RD, CHICAGO, IL 60613-2408
(773) 940-1612
Mailing address
1918 W IRVING PARK RD, CHICAGO, IL 60613-2408
(773) 940-1612
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
036101658
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20000890
—
IL
Enumeration date
09/01/2015
Last updated
09/01/2015
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