| Illinois Doctors On Demand | |
|
4900 N Pulaski Rd Chicago IL 60630-2813 | |
| (847) 530-5916 | |
| (773) 904-0393 |
| Full Name | Illinois Doctors On Demand |
|---|---|
| Speciality | Family Medicine |
| Location | 4900 N Pulaski Rd, Chicago, Illinois |
| Authorized Official Name and Position | Delia Famanas (PRESIDENT/CEO) |
| Authorized Official Contact | 8475305916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois Doctors On Demand 4900 N Pulaski Rd Chicago IL 60630-2813 Ph: (847) 530-5916 | Illinois Doctors On Demand 4900 N Pulaski Rd Chicago IL 60630-2813 Ph: (847) 530-5916 |
| NPI Number | 1780148072 |
|---|---|
| Provider Enumeration Date | 01/30/2019 |
| Last Update Date | 02/07/2021 |
| Medicare PECOS PAC ID | 7416297916 |
|---|---|
| Medicare Enrollment ID | O20190320001158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780148072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Myrlie L Casco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093768004 PECOS PAC ID: 9335041375 Enrollment ID: I20040121000992 |
| Provider Name | Gregg M Delossantos |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1184886517 PECOS PAC ID: 1254234016 Enrollment ID: I20040129000273 |
| Provider Name | Rosita S Hernandez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184712887 PECOS PAC ID: 9335102623 Enrollment ID: I20041201000562 |
| Provider Name | Wilfredo G Dacuycuy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407818545 PECOS PAC ID: 6709844608 Enrollment ID: I20041223000093 |
| Provider Name | Rafael Roxas Castro |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1417046020 PECOS PAC ID: 1759472236 Enrollment ID: I20070813000631 |
| Provider Name | Isabel F Faircloth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851320568 PECOS PAC ID: 0042393894 Enrollment ID: I20080216000102 |
| Provider Name | Yongsoo Kwon |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1043478555 PECOS PAC ID: 8022246743 Enrollment ID: I20140102000067 |
| Provider Name | Grace Nwaka Wabomnor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548725799 PECOS PAC ID: 0042552200 Enrollment ID: I20190508002619 |
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