Healthcare Provider Details

I. General information

NPI: 1144434044
Provider Name (Legal Business Name): ILLINOIS HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 N KILBOURN AVE
CHICAGO IL
60646-5912
US

IV. Provider business mailing address

5650 N KILBOURN AVE
CHICAGO IL
60646-5912
US

V. Phone/Fax

Practice location:
  • Phone: 773-814-2844
  • Fax:
Mailing address:
  • Phone: 773-814-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. MOHAMMED RAFIUDDIN SHABBIR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-814-2844