Provider Demographics
NPI:1124309398
Name:NORTH CHICAGO MEDICAL LLC
Entity type:Organization
Organization Name:NORTH CHICAGO MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODZEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-745-0391
Mailing Address - Street 1:2649 N LARAMIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1613
Mailing Address - Country:US
Mailing Address - Phone:773-745-0391
Mailing Address - Fax:773-745-3506
Practice Address - Street 1:2649 N LARAMIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1613
Practice Address - Country:US
Practice Address - Phone:773-745-0391
Practice Address - Fax:773-745-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment