Healthcare Provider Details

I. General information

NPI: 1336776954
Provider Name (Legal Business Name): ALMUSADDY MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MCLEAN BLVD
ELGIN IL
60123-3275
US

IV. Provider business mailing address

6626 BENTLEY AVE
DARIEN IL
60561-3807
US

V. Phone/Fax

Practice location:
  • Phone: 815-302-3660
  • Fax:
Mailing address:
  • Phone: 815-302-3660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MOUSAB ALMUSADDY
Title or Position: PRESIDENT
Credential: M.D
Phone: 815-302-3660