MEDICARE: FAMILY HEALTH PREVENTION & CARE CENTER, INC.

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1801042494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH PREVENTION & CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	333 E IL ROUTE 83
Second Line	:	SUITE 106
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4214
Country	:	US
Telephone Number	:	847-566-0003
Fax Number	:	847-566-5503

Provider Business Practice Location Address
First Line	:	333 E IL ROUTE 83
Second Line	:	SUITE 106
City	:	MUNDELEIN
State	:	IL
Zip	:	60060-4214
Country	:	US
Telephone Number	:	847-566-0003
Fax Number	:	847-566-5503

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ARTUR G. DJAGARIAN
Credential	:	M.D.
Telephone Number	:	847-909-5153

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	01/16/2009

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