Healthcare Provider Details

I. General information

NPI: 1013638113
Provider Name (Legal Business Name): FOMEAK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 N LINCOLN AVE STE 112
CHICAGO IL
60659-4672
US

IV. Provider business mailing address

5875 N LINCOLN AVE STE 112
CHICAGO IL
60659-4672
US

V. Phone/Fax

Practice location:
  • Phone: 773-501-4833
  • Fax: 773-733-4983
Mailing address:
  • Phone: 773-501-4833
  • Fax: 773-733-4983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: ABOURAHMAN M SANI
Title or Position: OWNER
Credential:
Phone: 773-501-4833