| Instavaxx Llc | |
|
2674 N Halsted St Chicago IL 60614-2361 | |
| (773) 697-3729 | |
| Not Available |
| Full Name | Instavaxx Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2674 N Halsted St, Chicago, Illinois |
| Authorized Official Name and Position | Capri Reese (OWNER) |
| Authorized Official Contact | 7735747263 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Instavaxx Llc 720 S Wells St Apt 2512 Chicago IL 60607-4796 Ph: (773) 697-3729 | Instavaxx Llc 2674 N Halsted St Chicago IL 60614-2361 Ph: (773) 697-3729 |
| NPI Number | 1134793771 |
|---|---|
| Provider Enumeration Date | 05/18/2021 |
| Last Update Date | 07/01/2022 |
| Medicare PECOS PAC ID | 7911305586 |
|---|---|
| Medicare Enrollment ID | O20211012002188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134793771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| Provider Name | Rajesh T Iyengar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821023714 PECOS PAC ID: 3274591821 Enrollment ID: I20041229000208 |
| Provider Name | Capri M Reese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841640711 PECOS PAC ID: 8426336264 Enrollment ID: I20161028000648 |
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