Provider Demographics
NPI:1639309313
Name:FIRST CHOICE MEDICAL & REHAB CENTER
Entity Type:Organization
Organization Name:FIRST CHOICE MEDICAL & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SALOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-385-6200
Mailing Address - Street 1:5646 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-4150
Mailing Address - Country:US
Mailing Address - Phone:773-385-6200
Mailing Address - Fax:773-385-6222
Practice Address - Street 1:5646 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-4150
Practice Address - Country:US
Practice Address - Phone:773-385-6200
Practice Address - Fax:773-385-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.047521208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13079Medicare UPIN