Healthcare Provider Details

I. General information

NPI: 1699834754
Provider Name (Legal Business Name): PULMONARY CONSULTANTS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10604 SOUTHWEST HIGHWAY
CHICAGO RIDGE IL
60415-2717
US

IV. Provider business mailing address

10604 SOUTHWEST HIGHWAY
CHICAGO RIDGE IL
60415-2717
US

V. Phone/Fax

Practice location:
  • Phone: 708-371-8006
  • Fax: 708-389-6630
Mailing address:
  • Phone: 708-371-8006
  • Fax: 708-389-6630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042617969
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number042617969
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number042617969
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number042617969
License Number StateIL

VIII. Authorized Official

Name: DR. MOHAMMED Z SAHLOUL
Title or Position: OWNER
Credential:
Phone: 708-371-6009