Provider profile · NPI 1245317536

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Family Medicine · Chicago, IL · NPI 1245317536 · No federal exclusion match

✔ Verified against the public CMS NPPES registry & HHS-OIG LEIE as of Jun 21, 2026. Source-linked, daily-refreshed. Public data only — no PHI.

Registry details

Type

Organization

Primary specialty

Family Medicine

Enumerated

Nov 1, 2006

License(s)

036110045 (IL)

Addresses on file

PurposeAddressCity/StatePhone
MAILING2222 W DIVISION ST SUITE 260Chicago, IL 60622-2717773-227-3770
LOCATION2222 W DIVISION ST SUITE 260Chicago, IL 60622-2717773-227-3770

View on NPPES registry ↗

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