Provider Demographics
NPI:1578738662
Name:KUJI HEALTH CONCEPTS
Entity Type:Organization
Organization Name:KUJI HEALTH CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:630-384-1254
Mailing Address - Street 1:7906 S CRANDON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1146
Mailing Address - Country:US
Mailing Address - Phone:773-768-5707
Mailing Address - Fax:
Practice Address - Street 1:7906 S CRANDON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1146
Practice Address - Country:US
Practice Address - Phone:773-768-5707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36117052302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01637572OtherBCBS
IL216403OtherMEDICARE GROUP NUMBER
IL036117052Medicaid
ILK50555Medicare UPIN