Healthcare Provider Details

I. General information

NPI: 1710352091
Provider Name (Legal Business Name): HARIS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E LAKE ST STE 102
ADDISON IL
60101-2873
US

IV. Provider business mailing address

1252 OGDEN AVE STE B
DOWNERS GROVE IL
60515-2740
US

V. Phone/Fax

Practice location:
  • Phone: 630-782-9780
  • Fax: 630-782-9781
Mailing address:
  • Phone: 630-847-7880
  • Fax: 630-559-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JABEEN FATIMA
Title or Position: MANAGER
Credential:
Phone: 630-847-7880