Basic Information
| Provider Information | |||||||||
| NPI: | 1356365027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXTENDED CARE SPECIALIST, LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34278 EAGLE WAY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606781342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307340200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3435 W VAN BUREN ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606243312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732653583 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LADIPO | ||||||||
| AuthorizedOfficialFirstName: | TUNJI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7735505550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.