Healthcare Provider Details

I. General information

NPI: 1114357092
Provider Name (Legal Business Name): MR. ABDUL HUSSEIN DARKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11808 S PULASKI RD
ALSIP IL
60803
US

IV. Provider business mailing address

11808 SOUTH PALASKI STREET
ALSIP IL
60803-1608
US

V. Phone/Fax

Practice location:
  • Phone: 708-668-2560
  • Fax: 708-489-6249
Mailing address:
  • Phone: 708-668-2560
  • Fax: 708-489-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-067615
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: