Organization
CHICAGO MEDICAL CENTER LIMITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YONGSOO KWON M.D. (PRESIDENT)
(773) 772-5111
Entity
Organization
Contact information
Practice address
3650 W ARMITAGE AVE, CHICAGO, IL 60647-3611
(773) 772-5111
(773) 772-5114
Mailing address
3650 W ARMITAGE AVE, CHICAGO, IL 60647-3611
(773) 772-5111
(773) 772-5114
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036070641
IL
207R00000X
Internal Medicine Physician
036120995
IL
207R00000X
Internal Medicine Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036070641
STATE LICENSE
IL
Enumeration date
07/27/2015
Last updated
08/18/2015
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