Chicago Age Management Institute

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

Legal business name

CHICAGO AGE MANAGEMENT INSTITUTE

Practice address

60 Revere Dr Ste 820
Northbrook, IL 60062-1580

Phone

(847) 905-9505

Fax

(847) 905-7344

NPI assigned

Jun 5, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrak Rosenbloom, MD

Title

Chief Medical Officer, Ceo

Phone

(847) 905-9505

Specialties & licenses 1

Addresses

Other names 1

• LIFEFORCE Medical Institute Doing business as

Tax ID family

Chicago Age Management Institute2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lifeforce Medical Institute

  • Public Health & General Preventive Medicine Physician
  • Northbrook, IL
  • NPI 1588078844
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370390400000",
    "number": "1083052609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 REVERE DR STE 820",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621580",
            "telephone_number": "847-905-9505",
            "fax_number": "847-905-7344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 REVERE DR STE 820",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621580",
            "telephone_number": "847-905-9505",
            "fax_number": "847-905-7344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO AGE MANAGEMENT INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-05",
        "last_updated": "2013-06-05",
        "status": "A",
        "authorized_official_last_name": "ROSENBLOOM",
        "authorized_official_first_name": "MRAK",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER, CEO",
        "authorized_official_telephone_number": "847-905-9505",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFEFORCE Medical Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly Lynn Chenault, R.PH.
• Rebecca Cherney, OT
• Annet Chernyhovsky, PSYD
• Vridhi Chhabria
• Gene Z Chiao, MD
• Chicago Clinical Laboratories, LTD
• Chicago Endovascular Center
• Chicago Family Acupuncture, LLC
• Chicago Genetic Consultants, LLC
• Chicago Mental Health Institute LLC

• Public Health & General Preventive Medicine Physician in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Public Health & General Preventive Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.