Provider Demographics
NPI:1083052609
Name:CHICAGO AGE MANAGEMENT INSTITUTE
Entity Type:Organization
Organization Name:CHICAGO AGE MANAGEMENT INSTITUTE
Other - Org Name:LIFEFORCE MEDICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:MRAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-905-9505
Mailing Address - Street 1:60 REVERE DR STE 820
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1580
Mailing Address - Country:US
Mailing Address - Phone:847-905-9505
Mailing Address - Fax:847-905-7344
Practice Address - Street 1:60 REVERE DR STE 820
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1580
Practice Address - Country:US
Practice Address - Phone:847-905-9505
Practice Address - Fax:847-905-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty