Healthcare Provider Details

I. General information

NPI: 1235340340
Provider Name (Legal Business Name): NAJMULSAHAR A BAIG ENDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELEZEBETH S BAKAS ENDT

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18808 W COTTAGE AVE
LAKE VILLA IL
60046-9017
US

IV. Provider business mailing address

18808 W COTTAGE AVE
LAKE VILLA IL
60046-9017
US

V. Phone/Fax

Practice location:
  • Phone: 847-708-1678
  • Fax: 847-223-4086
Mailing address:
  • Phone: 847-708-1678
  • Fax: 847-223-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number000828590
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: