Provider Demographics
NPI:1841590163
Name:CHICAGO EXPRESS DOCTORS, INC.
Entity Type:Organization
Organization Name:CHICAGO EXPRESS DOCTORS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-929-4492
Mailing Address - Street 1:520 N KINGSBURY ST
Mailing Address - Street 2:# 3905
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8766
Mailing Address - Country:US
Mailing Address - Phone:312-929-4492
Mailing Address - Fax:312-929-4493
Practice Address - Street 1:520 N KINGSBURY ST UNIT 3905
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-8779
Practice Address - Country:US
Practice Address - Phone:312-929-4492
Practice Address - Fax:312-929-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49403Medicare UPIN