Healthcare Provider Details

I. General information

NPI: 1326233735
Provider Name (Legal Business Name): MOBILE DOCTORS MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 N NORTH BRANCH ST SUITE 210
CHICAGO IL
60622-2473
US

IV. Provider business mailing address

1229 N NORTH BRANCH ST SUITE 210
CHICAGO IL
60622-2473
US

V. Phone/Fax

Practice location:
  • Phone: 312-939-5090
  • Fax:
Mailing address:
  • Phone: 312-939-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DIKE AJIRI
Title or Position: CEO
Credential:
Phone: 312-617-2122