Healthcare Provider Details

I. General information

NPI: 1497408371
Provider Name (Legal Business Name): CARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 W LAWRNCE AVE STE 1W
CHICAGO IL
60625-5203
US

IV. Provider business mailing address

3300 W LAWRNCE AVE STE 1W
CHICAGO IL
60625-5203
US

V. Phone/Fax

Practice location:
  • Phone: 833-363-3522
  • Fax:
Mailing address:
  • Phone: 833-363-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MOHAMMED RIHAN AHAMED RIFAI
Title or Position: PRESIDENT
Credential: BSC
Phone: 833-363-3522