| Chicago Medical Clinic Llc | |
|
200 S Greenleaf St Suite A Gurnee IL 60031-3398 | |
| (847) 596-4521 | |
| Not Available |
| Full Name | Chicago Medical Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 200 S Greenleaf St, Gurnee, Illinois |
| Authorized Official Name and Position | John R Kapoor (PHYSICIAN) |
| Authorized Official Contact | 8475964521 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chicago Medical Clinic Llc 200 S Greenleaf St Suite A Gurnee IL 60031-3398 Ph: (847) 596-4521 | Chicago Medical Clinic Llc 200 S Greenleaf St Suite A Gurnee IL 60031-3398 Ph: (847) 596-4521 |
| NPI Number | 1154640571 |
|---|---|
| Provider Enumeration Date | 05/25/2010 |
| Last Update Date | 06/07/2013 |
| Medicare PECOS PAC ID | 5092830950 |
|---|---|
| Medicare Enrollment ID | O20100915000614 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154640571 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | (* (Not Available)) | Primary |
| Provider Name | John R Kapoor |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1497887038 PECOS PAC ID: 4486758018 Enrollment ID: I20090710000228 |
| Provider Name | Roger Kapoor |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1154501245 PECOS PAC ID: 3072783497 Enrollment ID: I20110825000740 |
| Provider Name | Robert Paul Cafe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437651072 PECOS PAC ID: 8022371590 Enrollment ID: I20180416000555 |
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