MEDICARE: SIBLEY FAMILY MEDICAL CENTER SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036071269	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265690291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIBLEY FAMILY MEDICAL CENTER SC

Provider Business Mailing Address
First Line	:	1756 SIBLEY BLVD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2215
Country	:	US
Telephone Number	:	708-730-3900
Fax Number	:	708-730-7298

Provider Business Practice Location Address
First Line	:	1756 SIBLEY BLVD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-2215
Country	:	US
Telephone Number	:	708-730-3900
Fax Number	:	708-730-7298

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SALIM KASSAM
Credential	:	MD
Telephone Number	:	708-730-3900

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	06/09/2008

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Directions to “SIBLEY FAMILY MEDICAL CENTER SC ” Practice Location

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