Healthcare Provider Details

I. General information

NPI: 1528802956
Provider Name (Legal Business Name): ELITE PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9634 S ROBERTS RD STE 100
HICKORY HILLS IL
60457-2238
US

IV. Provider business mailing address

9634 S ROBERTS RD STE 100
HICKORY HILLS IL
60457-2238
US

V. Phone/Fax

Practice location:
  • Phone: 708-741-7944
  • Fax: 708-741-7941
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ABDELKHALIQ ISAM QASEM
Title or Position: OWNER
Credential:
Phone: 708-741-7944