Provider Demographics
NPI:1538205059
Name:CHICAGO MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:CHICAGO MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERSTING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-956-0099
Mailing Address - Street 1:515 W ALGONQUIN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4440
Mailing Address - Country:US
Mailing Address - Phone:847-956-0388
Mailing Address - Fax:847-956-0379
Practice Address - Street 1:515 W ALGONQUIN RD
Practice Address - Street 2:STE 110
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4440
Practice Address - Country:US
Practice Address - Phone:847-956-0388
Practice Address - Fax:847-956-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206991Medicare PIN
IL207010Medicare PIN
IL5109990001Medicare NSC