Chicago Polyclinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

CHICAGO POLYCLINIC LLC

Doing business as

Devon Poly Clinic

Practice address

2446 W Devon Ave
Chicago, IL 60659-1913

Phone

(773) 761-0500

NPI assigned

Sep 8, 2020

Last updated

Jul 8, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mohamed S Sirajudeen

Title

Ceo

Phone

(773) 521-6666

Specialties & licenses 1

Addresses

Other names 1

• Devon Poly Clinic Doing business as

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

{
    "created_epoch": "1599523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657238400000",
    "number": "1841804879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2446 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606591913",
            "telephone_number": "773-761-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2446 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606591913",
            "telephone_number": "773-761-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO POLYCLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-08",
        "last_updated": "2022-07-08",
        "certification_date": "2022-07-08",
        "status": "A",
        "authorized_official_last_name": "SIRAJUDEEN",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "773-521-6666"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Devon Poly Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Devon Poly Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2022; 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.