Healthcare Provider Details

I. General information

NPI: 1609207661
Provider Name (Legal Business Name): BROADWAY MEDICAL CLINIC, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 WARREN AVE
BELLWOOD IL
60104-2066
US

IV. Provider business mailing address

947 S MANNHEIM RD
WESTCHESTER IL
60154-2515
US

V. Phone/Fax

Practice location:
  • Phone: 708-343-1300
  • Fax: 708-345-8965
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AFSOON KARIMI
Title or Position: OWNER
Credential: M.D.
Phone: 708-343-1300