| Chicago Department Of Public Health Revenue 3200 | |
|
333 S State St Revenue 200 Chicago IL 60604-3900 | |
| (312) 747-9443 | |
| (312) 747-9447 |
| Full Name | Chicago Department Of Public Health Revenue 3200 |
|---|---|
| Speciality | Clinic/Center |
| Location | 333 S State St, Chicago, Illinois |
| Authorized Official Name and Position | Sarai M Jackson (DIRECTOR OF REVENUE) |
| Authorized Official Contact | 3127479443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chicago Department Of Public Health Revenue 3200 333 S State St Revenue 200 Chicago IL 60604-3900 Ph: (312) 747-9443 | Chicago Department Of Public Health Revenue 3200 333 S State St Revenue 200 Chicago IL 60604-3900 Ph: (312) 747-9443 |
| NPI Number | 1194725192 |
|---|---|
| Provider Enumeration Date | 08/01/2005 |
| Last Update Date | 05/27/2008 |
| Medicare PECOS PAC ID | 4486540929 |
|---|---|
| Medicare Enrollment ID | O20040303001160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194725192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (Illinois) | Primary |
| Provider Name | Juanita M Mosquera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003927229 PECOS PAC ID: 3375549710 Enrollment ID: I20061009000168 |
| Provider Name | Julia Morita |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821161514 PECOS PAC ID: 9830291806 Enrollment ID: I20070221000479 |
| Provider Name | Subhash C Goyal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1386617694 PECOS PAC ID: 8022113075 Enrollment ID: I20070419000303 |
| Provider Name | John T Carlsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467428037 PECOS PAC ID: 8022114081 Enrollment ID: I20070508000307 |
| Provider Name | Susan L Pelton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003947847 PECOS PAC ID: 0345340360 Enrollment ID: I20070705000214 |
| Provider Name | Sylvia A Santos |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1710944111 PECOS PAC ID: 2365535309 Enrollment ID: I20070906000564 |
| Provider Name | Nancy L Gajewski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538256276 PECOS PAC ID: 6901990860 Enrollment ID: I20070922000048 |
| Provider Name | Shilynda S Tolbert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558334532 PECOS PAC ID: 6204923808 Enrollment ID: I20071029000736 |
| Provider Name | Pamela Kaden |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811104706 PECOS PAC ID: 3870682735 Enrollment ID: I20071130000291 |
| Provider Name | Angela B Sims |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083680797 PECOS PAC ID: 8729121959 Enrollment ID: I20100216000242 |
| Provider Name | Esther Y Liu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154401750 PECOS PAC ID: 1052561313 Enrollment ID: I20121022000601 |
| Provider Name | Cortland Jesse Lohff |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1982927166 PECOS PAC ID: 9133371446 Enrollment ID: I20121213000345 |
| Provider Name | Roweine Q Staszcuk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699857243 PECOS PAC ID: 5890933253 Enrollment ID: I20130524000622 |
| Provider Name | Janice F Huber |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649474404 PECOS PAC ID: 6901991819 Enrollment ID: I20131111000101 |
| Provider Name | Michael Thomas Churchwell |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1306075270 PECOS PAC ID: 9032341276 Enrollment ID: I20140702001522 |
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