Provider Demographics
NPI:1780616102
Name:BAZELL CLINIC, LLC
Entity type:Organization
Organization Name:BAZELL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:YEUN
Authorized Official - Middle Name:HIE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-738-3111
Mailing Address - Street 1:3520 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1317
Mailing Address - Country:US
Mailing Address - Phone:773-247-4900
Mailing Address - Fax:773-247-8145
Practice Address - Street 1:3520 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1317
Practice Address - Country:US
Practice Address - Phone:773-247-4900
Practice Address - Fax:773-247-8145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty