| Haymarket Center | |
|
124 N Sangamon St Chicago IL 60607-2202 | |
| (312) 226-7984 | |
| (312) 226-8048 |
| Full Name | Haymarket Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 124 N Sangamon St, Chicago, Illinois |
| Authorized Official Name and Position | Gigi Fuller (DIRECTOR OF QA) |
| Authorized Official Contact | 3122267984 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Haymarket Center 932 W Washington Blvd Chicago IL 60607-2217 Ph: (312) 226-7984 | Haymarket Center 124 N Sangamon St Chicago IL 60607-2202 Ph: (312) 226-7984 |
| NPI Number | 1457004046 |
|---|---|
| Provider Enumeration Date | 02/02/2022 |
| Last Update Date | 06/13/2023 |
| Certification Date | 06/13/2023 |
| Medicare PECOS PAC ID | 7517354178 |
|---|---|
| Medicare Enrollment ID | O20220428002128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457004046 | NPI | - | NPPES |
| Provider Name | Mary E Fry |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801996368 PECOS PAC ID: 0446213888 Enrollment ID: I20041108000392 |
| Provider Name | Jeffrey M Tilkin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578534483 PECOS PAC ID: 1153516018 Enrollment ID: I20101117000887 |
| Provider Name | Michael B Baldinger |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598879223 PECOS PAC ID: 6901868561 Enrollment ID: I20110112000636 |
| Provider Name | Juan P Mercado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962719419 PECOS PAC ID: 4688854599 Enrollment ID: I20110210000108 |
| Provider Name | Judith Cothran |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1942263090 PECOS PAC ID: 8123298734 Enrollment ID: I20110908001904 |
| Provider Name | Aleen Z Shah |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942612668 PECOS PAC ID: 3173747631 Enrollment ID: I20140624001671 |
| Provider Name | Elizabeth Anne Kiracofe |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1336400217 PECOS PAC ID: 5092956631 Enrollment ID: I20160829002697 |
| Provider Name | Jennifer Danielle Mainor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467979260 PECOS PAC ID: 5991079899 Enrollment ID: I20170915001121 |
| Provider Name | Shabana Cano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811446669 PECOS PAC ID: 4385901149 Enrollment ID: I20171202000213 |
| Provider Name | Kimberly Joy Foster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407435985 PECOS PAC ID: 5890169890 Enrollment ID: I20230314001918 |
| Provider Name | Christopher James Lucia |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356139901 PECOS PAC ID: 4486121746 Enrollment ID: I20260424000873 |
| Provider Name | Unyime Ekanem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043912843 PECOS PAC ID: 7517435290 Enrollment ID: I20260512000264 |
| Provider Name | Sarah Wood |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275483711 PECOS PAC ID: 3072084953 Enrollment ID: I20260602002951 |
| Provider Name | Jerry Knight |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669155453 PECOS PAC ID: 6709357338 Enrollment ID: I20260604003240 |
| Provider Name | Alexander George Bauman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073233003 PECOS PAC ID: 6608347075 Enrollment ID: I20260605003101 |
| Provider Name | Jessica Lynn Dubuar |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528423936 PECOS PAC ID: 5890267447 Enrollment ID: I20260615001448 |
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