Provider Demographics
NPI:1326047788
Name:CHICAGO HAMLIN FAMILY PRACTICE SPECIALISTS LTD
Entity Type:Organization
Organization Name:CHICAGO HAMLIN FAMILY PRACTICE SPECIALISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LASALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-235-0626
Mailing Address - Street 1:520 E. 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148
Mailing Address - Country:US
Mailing Address - Phone:630-874-2542
Mailing Address - Fax:
Practice Address - Street 1:3758 W. CHICAGO AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651
Practice Address - Country:US
Practice Address - Phone:773-235-0626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350590Medicare PIN