Organization
63RD ADVANCED HEALTH CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALESIA CHAIKA (OWNER)
(847) 904-7500
Entity
Organization
Contact information
Practice address
1249 W 63RD ST, CHICAGO, IL 60636-1947
(847) 904-7500
(847) 904-7502
Mailing address
1249 W 63RD ST, CHICAGO, IL 60636-1947
(847) 904-7500
(847) 904-7502
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
08/14/2009
Last updated
08/14/2009
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