Organization
CHICAGO FAMILY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMELIA RODRIGUEZ (CHIEF FINANCIAL OFFICER)
(773) 768-5000
Entity
Organization
Contact information
Practice address
2320 E 93RD ST, FLOOR 1, CHICAGO, IL 60617-3983
(773) 967-1135
(773) 374-1621
Mailing address
9119 S EXCHANGE AVE, CHICAGO, IL 60617-4225
(773) 768-5000
(773) 374-1621
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
1769357
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14D1059438
CLIA LICENSE
IL
01
—
1769357
CITY LICENSE
IL
Enumeration date
06/05/2007
Last updated
04/20/2008
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