Illinois Doctors on Demand
Organization Active NPI Family Medicine Physician · Chicago, IL
NPI 1780148072 · NPPES record last updated Feb 7, 2021
Key facts
- NPI
- 1780148072
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ILLINOIS DOCTORS ON DEMAND
- Practice address
- 4900 N Pulaski Rd
Chicago, IL 60630-2813 - Phone
- (847) 530-5916
- Fax
- (773) 904-0393
- NPI assigned
- Jan 30, 2019
- Organization subpart
- No
Authorized official
- Name
- Delia Famanas
- Title
- President/Ceo
- Phone
- (847) 530-5916
Practitioners 12
-
Jamie Cadet, APRN, FNP-BC
-
Myrlie Larena Casco, M.D.
-
Rafael R Castro, MD FACS
-
Grace Nwaka Wabomnor, ANP
-
Delia Famanas, RN
-
Mubeen Yamani, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190320001158 | IL | Part B Supplier - Clinic/Group Practice | 7416297916 |
Receives reassigned benefits from 10 practitioners Practice locations: Chicago, IL |
National Provider Directory
Locations
4900 N Pulaski Rd
Chicago, IL 60630
Phone (847) 530-5916
5940 W Touhy Ave
Ste 310
Niles, IL 60714
Phone (847) 530-5916
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
4900 N Pulaski Rd
Chicago, IL 60630-2813
Mailing address
4900 N Pulaski Rd
Chicago, IL 60630-2813
Phone (847) 530-5916
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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 Feb 7, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.