Healthcare Provider Details

I. General information

NPI: 1356905194
Provider Name (Legal Business Name): ILLINOIS PRIMARY & IMMEDIATE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2298 COUNTY LINE RD STE B
ALGONQUIN IL
60102-2561
US

IV. Provider business mailing address

PO BOX 425
BLOOMINGDALE IL
60108-0425
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-1344
  • Fax:
Mailing address:
  • Phone: 815-455-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUMAIRA JABEEN
Title or Position: PRESIDENT
Credential: MD
Phone: 630-336-8193