Provider Demographics
NPI:1891370292
Name:COVID MEDICAL SOLUTION ILLINOIS LLC
Entity Type:Organization
Organization Name:COVID MEDICAL SOLUTION ILLINOIS LLC
Other - Org Name:DOCTORS TEST CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-858-7638
Mailing Address - Street 1:20 W ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3809
Mailing Address - Country:US
Mailing Address - Phone:312-858-7638
Mailing Address - Fax:312-276-4452
Practice Address - Street 1:20 W ONTARIO ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3809
Practice Address - Country:US
Practice Address - Phone:312-858-7638
Practice Address - Fax:312-276-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care