Provider Demographics
NPI:1649629288
Name:EMERGENCY MEDICAL MEDICINE
Entity type:Organization
Organization Name:EMERGENCY MEDICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TUNJI
Authorized Official - Middle Name:
Authorized Official - Last Name:LADIPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-995-3000
Mailing Address - Street 1:7411 S INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2033
Mailing Address - Country:US
Mailing Address - Phone:773-574-7263
Mailing Address - Fax:
Practice Address - Street 1:2530 CRAWFORD AVE STE 307
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4972
Practice Address - Country:US
Practice Address - Phone:773-995-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-05
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012220146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Single Specialty