Provider Demographics
NPI:1992802664
Name:FAMILY CARE ASSOCIATES LTD
Entity type:Organization
Organization Name:FAMILY CARE ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-205-8200
Mailing Address - Street 1:PO BOX 14439
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-0439
Mailing Address - Country:US
Mailing Address - Phone:773-205-8200
Mailing Address - Fax:773-205-1222
Practice Address - Street 1:4438 N MIWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-6063
Practice Address - Country:US
Practice Address - Phone:773-205-8200
Practice Address - Fax:773-205-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086306Medicaid
IL036103291Medicaid
ILF72453Medicare UPIN
ILL78993Medicare ID - Type UnspecifiedDR GOMEZ