| Family Doc, Inc. | |
|
7207 S Stony Island Ave Chicago IL 60649-2806 | |
| (773) 940-1612 | |
| (773) 940-1567 |
| Full Name | Family Doc, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 7207 S Stony Island Ave, Chicago, Illinois |
| Authorized Official Name and Position | Adebayo Adel Bademosi (PRESIDENT) |
| Authorized Official Contact | 7739401612 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Doc, Inc. 7207 S Stony Island Ave Chicago IL 60649-2806 Ph: (773) 940-1612 | Family Doc, Inc. 7207 S Stony Island Ave Chicago IL 60649-2806 Ph: (773) 940-1612 |
| NPI Number | 1700117942 |
|---|---|
| Provider Enumeration Date | 01/28/2010 |
| Last Update Date | 04/29/2013 |
| Medicare PECOS PAC ID | 0042341471 |
|---|---|
| Medicare Enrollment ID | O20100629000851 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700117942 | NPI | - | NPPES |
| 036101658 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Adelanke Bademosi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346357076 PECOS PAC ID: 7810891173 Enrollment ID: I20031120000086 |
| Provider Name | Ebonie L Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871002675 PECOS PAC ID: 5294073060 Enrollment ID: I20190221000435 |
| Provider Name | Miyako S Streeter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225501356 PECOS PAC ID: 0749526481 Enrollment ID: I20191023000097 |
| Provider Name | Riskat Fadonougbo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154967230 PECOS PAC ID: 0042648461 Enrollment ID: I20200318002483 |
| Provider Name | Annie White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780271247 PECOS PAC ID: 8628483880 Enrollment ID: I20210219002598 |
| Provider Name | David Walters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780303735 PECOS PAC ID: 1951770437 Enrollment ID: I20221205001760 |
| Provider Name | Brandy Wade |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1962279489 PECOS PAC ID: 2567805096 Enrollment ID: I20240212002085 |
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