Healthcare Provider Details

I. General information

NPI: 1033532973
Provider Name (Legal Business Name): MINIMALLY INVASIVE THERAPY PARTNERS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 773-826-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: AHMAD IFTIKAR
Title or Position: PRESIDENT
Credential: MD
Phone: 773-550-5550