Healthcare Provider Details

I. General information

NPI: 1285974501
Provider Name (Legal Business Name): AMERICAN MOBILE PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2013
Last Update Date: 02/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6124 N MILWAUKEE AVE 10
CHICAGO IL
60646-3830
US

IV. Provider business mailing address

6124 N MILWAUKEE AVE 10
CHICAGO IL
60646-3830
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-8100
  • Fax: 773-774-8101
Mailing address:
  • Phone: 773-774-8100
  • Fax: 773-774-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RAZDAR KHAN MOHAMMAD
Title or Position: PRESIDENT
Credential:
Phone: 312-730-7860