| Illinois Doctors on Demand | |
|
4900 N Pulaski Rd Chicago IL 60630-2813 | |
| (847) 530-5916 | |
| (773) 904-0393 |
| Full Name | Illinois Doctors on Demand |
|---|---|
| Speciality | Family Medicine |
| Location | 4900 N Pulaski Rd, Chicago, Illinois |
| Authorized Official Name and Position | Delia Famanas (PRESIDENT/CEO) |
| Authorized Official Contact | 8475305916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois Doctors on Demand 4900 N Pulaski Rd Chicago IL 60630-2813 Ph: (847) 530-5916 | Illinois Doctors on Demand 4900 N Pulaski Rd Chicago IL 60630-2813 Ph: (847) 530-5916 |
| NPI Number | 1780148072 |
|---|---|
| Provider Enumeration Date | 01/30/2019 |
| Last Update Date | 02/07/2021 |
| Certification Date | 02/07/2021 |
| Medicare PECOS PAC ID | 7416297916 |
|---|---|
| Medicare Enrollment ID | O20190320001158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780148072 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Myrlie L Casco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093768004 PECOS PAC ID: 9335041375 Enrollment ID: I20040121000992 |
| Provider Name | Gregg M Delossantos |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1184886517 PECOS PAC ID: 1254234016 Enrollment ID: I20040129000273 |
| Provider Name | Rosita S Hernandez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184712887 PECOS PAC ID: 9335102623 Enrollment ID: I20041201000562 |
| Provider Name | Wilfredo G Dacuycuy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407818545 PECOS PAC ID: 6709844608 Enrollment ID: I20041223000093 |
| Provider Name | Maria Victoria Vela |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245201326 PECOS PAC ID: 2668465352 Enrollment ID: I20051115000810 |
| Provider Name | Rafael Roxas Castro |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1417046020 PECOS PAC ID: 1759472236 Enrollment ID: I20070813000631 |
| Provider Name | Grace Nwaka Wabomnor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548725799 PECOS PAC ID: 0042552200 Enrollment ID: I20190508002619 |
| Provider Name | Jamie Cadet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538844626 PECOS PAC ID: 4587024898 Enrollment ID: I20230718004035 |
| Provider Name | Mubeen Yamani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225861198 PECOS PAC ID: 5597296400 Enrollment ID: I20241002003654 |
| Provider Name | Meghana Dinesh Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750243788 PECOS PAC ID: 9739655952 Enrollment ID: I20260415002833 |
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