Healthcare Provider Details

I. General information

NPI: 1770516957
Provider Name (Legal Business Name): ISSAN HEALTH CARE GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N LARKIN AVE STE 100
JOLIET IL
60435-3449
US

IV. Provider business mailing address

815 N LARKIN AVE STE 100
JOLIET IL
60435-3449
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-7400
  • Fax: 157-447-4358
Mailing address:
  • Phone: 815-744-7400
  • Fax: 157-447-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NAZEER SHAIK
Title or Position: PRESIDENT
Credential: MD
Phone: 708-458-7170