Provider Demographics
NPI:1740463371
Name:CHICAGOCARE LLC
Entity type:Organization
Organization Name:CHICAGOCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-396-7689
Mailing Address - Street 1:7240 W AZURE DR
Mailing Address - Street 2:#165
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-4405
Mailing Address - Country:US
Mailing Address - Phone:702-396-7689
Mailing Address - Fax:702-645-9958
Practice Address - Street 1:7240 W AZURE DR
Practice Address - Street 2:#165
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4405
Practice Address - Country:US
Practice Address - Phone:702-396-7689
Practice Address - Fax:702-645-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV101462OtherMEDICARE GROUP