Healthcare Provider Details

I. General information

NPI: 1740396225
Provider Name (Legal Business Name): HAMPSHIRE CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 S STATE ST
HAMPSHIRE IL
60140-7010
US

IV. Provider business mailing address

153 S STATE ST
HAMPSHIRE IL
60140-7010
US

V. Phone/Fax

Practice location:
  • Phone: 847-683-3661
  • Fax:
Mailing address:
  • Phone: 847-683-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FARZANA S HOSAIN
Title or Position: OWNER
Credential: MD
Phone: 630-995-6635