Provider Demographics
NPI:1205012333
Name:CHICAGO MEG CENTER, LLC
Entity type:Organization
Organization Name:CHICAGO MEG CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-663-0384
Mailing Address - Street 1:11595 N MERIDIAN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6947
Mailing Address - Country:US
Mailing Address - Phone:317-663-0384
Mailing Address - Fax:
Practice Address - Street 1:5554 S HYDE PARK BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1909
Practice Address - Country:US
Practice Address - Phone:773-324-9200
Practice Address - Fax:773-324-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center