Organization
22ND CENTURY HEALTHCARE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BO HEADLAM MD (CEO)
(773) 362-5461
Entity
Organization
Contact information
Practice address
875 N MICHIGAN AVE, SUITE 3100, CHICAGO, IL 60611-1803
(773) 362-5461
Mailing address
3712 N BROADWAY ST, SUITE 629, CHICAGO, IL 60613-4235
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
05/09/2009
Last updated
05/09/2009
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