Healthcare Provider Details

I. General information

NPI: 1770906638
Provider Name (Legal Business Name): ALLIED MEDICAL ASSOCIATES, LTD.
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

2172 BLACKBERRY DR SUITE 206
GENEVA IL
60134-1102
US

IV. Provider business mailing address

2172 BLACKBERRY DR SUITE 206
GENEVA IL
60134-1102
US

V. Phone/Fax

Practice location:
  • Phone: 630-208-7735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BORIS M LEKAKH
Title or Position: ADMINISTRATOR
Credential:
Phone: 847-420-0700