| Mezame | |
|
3257 N Sheffield Ave Ste 110 Chicago IL 60657-2276 | |
| (312) 248-1915 | |
| (773) 304-9878 |
| Full Name | Mezame |
|---|---|
| Speciality | Counselor |
| Location | 3257 N Sheffield Ave Ste 110, Chicago, Illinois |
| Authorized Official Name and Position | Robert Manrique (OWNER) |
| Authorized Official Contact | 3122481915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mezame 3257 N Sheffield Ave Ste 110 Chicago IL 60657-2276 Ph: (312) 248-1915 | Mezame 3257 N Sheffield Ave Ste 110 Chicago IL 60657-2276 Ph: (312) 248-1915 |
| NPI Number | 1033719083 |
|---|---|
| Provider Enumeration Date | 10/29/2020 |
| Last Update Date | 12/12/2023 |
| Certification Date | 12/12/2023 |
| Medicare PECOS PAC ID | 6305222985 |
|---|---|
| Medicare Enrollment ID | O20221128000335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033719083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Robert Edward Manrique |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457639437 PECOS PAC ID: 8022494608 Enrollment ID: I20230214001063 |
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