Provider Demographics
NPI:1225372311
Name:CHICAGOLAND MEDICAL PC
Entity type:Organization
Organization Name:CHICAGOLAND MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:KAUF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-337-7968
Mailing Address - Street 1:1 E DELAWARE PLACE
Mailing Address - Street 2:SUITE 401B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5135
Mailing Address - Country:US
Mailing Address - Phone:312-337-7968
Mailing Address - Fax:312-337-4060
Practice Address - Street 1:1 E DELAWARE PLACE
Practice Address - Street 2:SUITE 401B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5135
Practice Address - Country:US
Practice Address - Phone:312-337-7968
Practice Address - Fax:312-337-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007889111N00000X
207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8150Medicare PIN
ILDT8459Medicare PIN