Healthcare Provider Details

I. General information

NPI: 1952609604
Provider Name (Legal Business Name): INTEGRATED CARE AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5011 N LINCOLN AVE
CHICAGO IL
60625-2611
US

IV. Provider business mailing address

5011 N LINCOLN AVE
CHICAGO IL
60625-2611
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-7700
  • Fax: 773-271-7700
Mailing address:
  • Phone: 773-271-7700
  • Fax: 773-271-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number036061660
License Number StateIL

VIII. Authorized Official

Name: DR. AMJAD ABDULLAH ZUREIKAT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-271-7700