Provider Demographics
NPI:1174903512
Name:INDEPENDENT PHYSICIANS' ACO OF CHICAGO, LLC
Entity type:Organization
Organization Name:INDEPENDENT PHYSICIANS' ACO OF CHICAGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VENETOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-989-6262
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3500
Mailing Address - Country:US
Mailing Address - Phone:773-989-6262
Mailing Address - Fax:
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3500
Practice Address - Country:US
Practice Address - Phone:773-989-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty