| New Southtown Medical Group S C | |
|
11000 S Halsted St Chicago IL 60628-3909 | |
| (630) 408-7011 | |
| Not Available |
| Full Name | New Southtown Medical Group S C |
|---|---|
| Speciality | Family Medicine |
| Location | 11000 S Halsted St, Chicago, Illinois |
| Authorized Official Name and Position | Bianca N Chalokwu (PRESIDENT) |
| Authorized Official Contact | 6304087011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Southtown Medical Group S C 11000 S Halsted St Chicago IL 60628-3909 Ph: (630) 408-7011 | New Southtown Medical Group S C 11000 S Halsted St Chicago IL 60628-3909 Ph: (630) 408-7011 |
| NPI Number | 1134508997 |
|---|---|
| Provider Enumeration Date | 05/27/2015 |
| Last Update Date | 05/27/2015 |
| Medicare PECOS PAC ID | 0547572349 |
|---|---|
| Medicare Enrollment ID | O20150708001267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134508997 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Cesar Augusto Carranza |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447207022 PECOS PAC ID: 3779473996 Enrollment ID: I20040319000180 |
| Provider Name | Rita J Mcguire |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1780634733 PECOS PAC ID: 5698748853 Enrollment ID: I20040816001135 |
| Provider Name | Rhonda Y Gans |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003830670 PECOS PAC ID: 2961465794 Enrollment ID: I20041111000648 |
| Provider Name | Olusoji A Peter |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225018203 PECOS PAC ID: 2264514561 Enrollment ID: I20080726000013 |
| Provider Name | Christian Oyibe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528423019 PECOS PAC ID: 3375845027 Enrollment ID: I20160112001902 |
| Provider Name | Jamilah F Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154796605 PECOS PAC ID: 7113223769 Enrollment ID: I20160309000240 |
| Provider Name | Asantewah F Daniels |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083076871 PECOS PAC ID: 7719285840 Enrollment ID: I20160406000452 |
| Provider Name | Delovely G Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013370857 PECOS PAC ID: 9133418627 Enrollment ID: I20160524000140 |
| Provider Name | Leshaun Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043679681 PECOS PAC ID: 0941580823 Enrollment ID: I20161212000651 |
| Provider Name | Sherree Mccool |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104354257 PECOS PAC ID: 5799041059 Enrollment ID: I20171102002562 |
| Provider Name | Taryrsha Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821552761 PECOS PAC ID: 7911246368 Enrollment ID: I20190228002263 |
| Provider Name | Folarin Opakunle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952879777 PECOS PAC ID: 7719025469 Enrollment ID: I20190514003122 |
| Provider Name | Chakika Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770047615 PECOS PAC ID: 1355676974 Enrollment ID: I20190718000300 |
| Provider Name | Sylvere Roland Malonga |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497311104 PECOS PAC ID: 1557272796 Enrollment ID: I20200529000009 |
| Provider Name | Ismail Adebayo Oyebode |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669079018 PECOS PAC ID: 0547673220 Enrollment ID: I20210120000584 |
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