MEDICARE: PAK AMERICAN MEDICAL CENTER, NFP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QH0100X	Health Service Clinic/Center
2	261QP2300X	Primary Care Clinic/Center
3	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1710493572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAK AMERICAN MEDICAL CENTER, NFP

Provider Business Mailing Address
First Line	:	6201 N CALIFORNIA AVE STE 110
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2672
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 N CALIFORNIA AVE STE 110
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2672
Country	:	US
Telephone Number	:	773-381-1800
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MUBASHER FEROZE
Credential	:
Telephone Number	:	773-414-9438

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	12/15/2017

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