| Cdph | |
|
641 W 63rd St Chicago IL 60621-2032 | |
| (312) 747-7831 | |
| Not Available |
| Full Name | Cdph |
|---|---|
| Speciality | Clinic/center - Community Health |
| Location | 641 W 63rd St, Chicago, Illinois |
| Authorized Official Name and Position | Matthew W Beaudet (FIRST DEPUTY COMMISSIONER) |
| Authorized Official Contact | 3127479889 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cdph 333 S State St Room 200 - Revenue Chicago IL 60604-3900 Ph: (312) 747-9545 | Cdph 641 W 63rd St Chicago IL 60621-2032 Ph: (312) 747-7831 |
| NPI Number | 1568788875 |
|---|---|
| Provider Enumeration Date | 04/12/2010 |
| Last Update Date | 04/12/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568788875 | NPI | - | NPPES |
| 14D0664774 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |
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