Healthcare Provider Details

I. General information

NPI: 1821359464
Provider Name (Legal Business Name): BOLLINGBROOK URGENT CARE S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 S BOLINGBROOK DR
BOLINGBROOK IL
60440-2852
US

IV. Provider business mailing address

148 S BOLINGBROOK DR
BOLINGBROOK IL
60440-2852
US

V. Phone/Fax

Practice location:
  • Phone: 630-914-5373
  • Fax: 630-410-8528
Mailing address:
  • Phone: 630-914-5373
  • Fax: 630-410-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number036084178
License Number StateIL

VIII. Authorized Official

Name: DR. SALEHA KHAN
Title or Position: PRESIDENT
Credential: M.D
Phone: 630-430-3892