Healthcare Provider Details

I. General information

NPI: 1508922949
Provider Name (Legal Business Name): K QADIR SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 400
AURORA IL
60504-5894
US

IV. Provider business mailing address

2020 OGDEN AVE SUITE 400
AURORA IL
60504-5894
US

V. Phone/Fax

Practice location:
  • Phone: 630-499-2442
  • Fax: 630-499-2452
Mailing address:
  • Phone: 630-898-3535
  • Fax: 630-499-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36114031
License Number StateIL

VIII. Authorized Official

Name: DR. KHURRAM QADIR
Title or Position: PRESIDENT
Credential: MD
Phone: 630-639-7771