Healthcare Provider Details

I. General information

NPI: 1245053404
Provider Name (Legal Business Name): CHICAGO MEDICAL FMR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GRAND CANYON PKWY STE 201
HOFFMAN ESTATES IL
60169-1730
US

IV. Provider business mailing address

1000 GRAND CANYON PKWY STE 201
HOFFMAN ESTATES IL
60169-1730
US

V. Phone/Fax

Practice location:
  • Phone: 630-273-7004
  • Fax: 630-273-7432
Mailing address:
  • Phone: 630-273-7004
  • Fax: 630-273-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FATIMA SAEED
Title or Position: SOLE OWNER
Credential: DMD
Phone: 331-775-4461