Basic Information
| Provider Information | |||||||||
| NPI: | 1649629288 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGENCY MEDICAL MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7411 S INGLESIDE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606192033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735747263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2530 CRAWFORD AVE STE 307 | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602014972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739953000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2016 | ||||||||
| LastUpdateDate: | 06/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | LADIPO | ||||||||
| AuthorizedOfficialFirstName: | TUNJI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7739953000 | ||||||||
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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 | 146M00000X | 209012220 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Emergency Medical Service Providers | Emergency Medical Technician, Intermediate |
No ID Information.