Healthcare Provider Details

I. General information

NPI: 1053659052
Provider Name (Legal Business Name): MINIMALLY INVASIVE THERAPY PARTNERS S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 W WAYMAN ST UNIT 204 B
CHICAGO IL
60661-1296
US

IV. Provider business mailing address

5011 N LINCOLN AVE
CHICAGO IL
60625-6351
US

V. Phone/Fax

Practice location:
  • Phone: 844-834-6362
  • Fax: 855-497-2932
Mailing address:
  • Phone: 844-834-6362
  • Fax: 708-489-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. IFTIKHAR AHMAD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 844-834-6362