Provider Demographics
NPI:1073704128
Name:FAMILY FOCUSED HEALTHCARE
Entity Type:Organization
Organization Name:FAMILY FOCUSED HEALTHCARE
Other - Org Name:WAI CHEE CHEUNG-O'CARROLL, M.D., S.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAI
Authorized Official - Middle Name:CHEE
Authorized Official - Last Name:CHEUNG-O'CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-855-0100
Mailing Address - Street 1:1445 N HUNT CLUB RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2603
Mailing Address - Country:US
Mailing Address - Phone:847-855-0100
Mailing Address - Fax:847-855-0101
Practice Address - Street 1:1445 N HUNT CLUB RD
Practice Address - Street 2:SUITE 304
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2603
Practice Address - Country:US
Practice Address - Phone:847-855-0100
Practice Address - Fax:847-855-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932117OtherBLUE CROSS BLUE SHIELD ID
IL=========OtherTRICARE
IL209451Medicare PIN
IL=========OtherTRICARE
ILK08021Medicare PIN