Provider Demographics
NPI:1255606778
Name:CAMMI, LLC
Entity type:Organization
Organization Name:CAMMI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, FAAEM
Authorized Official - Phone:773-649-4154
Mailing Address - Street 1:1840 OAK AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3642
Mailing Address - Country:US
Mailing Address - Phone:773-649-4154
Mailing Address - Fax:773-453-3202
Practice Address - Street 1:1840 OAK AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3642
Practice Address - Country:US
Practice Address - Phone:773-649-4154
Practice Address - Fax:773-453-3202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.085053302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization