Provider Demographics
NPI:1790338358
Name:DOCTORS ON DEMAND- CHICAGO
Entity Type:Organization
Organization Name:DOCTORS ON DEMAND- CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMIEBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FAMANAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-530-5916
Mailing Address - Street 1:4900 N PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2813
Mailing Address - Country:US
Mailing Address - Phone:847-530-5916
Mailing Address - Fax:
Practice Address - Street 1:4900 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2813
Practice Address - Country:US
Practice Address - Phone:847-530-5916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty