Healthcare Provider Details

I. General information

NPI: 1710493572
Provider Name (Legal Business Name): PAK AMERICAN MEDICAL CENTER, NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2017
Last Update Date: 12/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 N CALIFORNIA AVE STE 110
CHICAGO IL
60659-2672
US

IV. Provider business mailing address

6201 N CALIFORNIA AVE STE 110
CHICAGO IL
60659-2672
US

V. Phone/Fax

Practice location:
  • Phone: 773-381-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MUBASHER FEROZE
Title or Position: MANAGER
Credential:
Phone: 773-414-9438