Provider Demographics
NPI:1003129024
Name:DOC CAM MEDICAL CENTER SC
Entity Type:Organization
Organization Name:DOC CAM MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHAPTCHET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-731-2700
Mailing Address - Street 1:2315 E 93RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3936
Mailing Address - Country:US
Mailing Address - Phone:773-731-2700
Mailing Address - Fax:773-363-2080
Practice Address - Street 1:2315 E 93RD ST STE 337
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3948
Practice Address - Country:US
Practice Address - Phone:773-731-2700
Practice Address - Fax:773-373-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL364429828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty