Healthcare Provider Details

I. General information

NPI: 1386650885
Provider Name (Legal Business Name): TAREK EL-SHIKH PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5764 S ARCHER AVE
CHICAGO IL
60638-1643
US

IV. Provider business mailing address

5764 S ARCHER AVE
CHICAGO IL
60638-1643
US

V. Phone/Fax

Practice location:
  • Phone: 773-284-0888
  • Fax: 773-284-0880
Mailing address:
  • Phone: 773-284-0888
  • Fax: 773-284-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number05003251A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number070006954
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.006954
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: