Cook County
Organization Active NPI Family Medicine Physician · Chicago, IL
NPI 1194356089 · NPPES record last updated Mar 2, 2020
Key facts
- NPI
- 1194356089
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- COOK COUNTY
- Practice address
- 3525 S Michigan Ave
Chicago, IL 60653-1019 - Phone
- (312) 945-4010
- NPI assigned
- Jan 29, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- COOK COUNTY
Authorized official
- Name
- Scott Andrle
- Title
- Director of Managed Care Operations
- Phone
- (312) 864-4649
Corporate family (same tax ID) 21
National Provider Directory
- Tax ID family
- Community Triage Center
- Part of
- Community Triage Center
Locations
3525 S Michigan Ave
Chicago, IL 60653
Phone (312) 945-4010
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
3525 S Michigan Ave
Chicago, IL 60653-1019
Mailing address
1900 W Polk St RM 220C
Chicago, IL 60612-3723
Other names
- Near South Health Center (FFS)
Other providers in Chicago, IL
- Christopher L Coogan
- Kathleen Coogan
- Cook County
- Cook County
- Cook County
- Cook County
- Cook County
- Cook County
- Cook County
- Cook County
All providers in Chicago, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.