Basic Information
| Provider Information | |||||||||
| NPI: | 1093837478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATHERINE MCAULEY HEALTH SERVICES | ||||||||
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| OtherOrganizationName: | DUNDEE FAMILY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2691 RELIABLE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606860026 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 119 WATERSTRADT COMMERCE DR | ||||||||
| Address2: | STE #1 | ||||||||
| City: | DUNDEE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481319695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345296060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | FAJA | ||||||||
| AuthorizedOfficialFirstName: | GARRY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 7349754101 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080H110140 | 01 | MI | BCBS BCN | OTHER |