Organization
CHICAGO AMBULATORY CARE CENTER, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE THOMAS AMPALLOOR M.D (PRESIDENT)
(773) 292-4501
Entity
Organization
Contact information
Practice address
1044 N MOZART ST, STE - 402, CHICAGO, IL 60622-2789
(773) 292-4501
Mailing address
1044 N MOZART ST, STE - 402, CHICAGO, IL 60622-2789
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036105483
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036105483
—
IL
Enumeration date
08/05/2012
Last updated
09/11/2021
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