Healthcare Provider Details

I. General information

NPI: 1497188692
Provider Name (Legal Business Name): ONSITE HEALTH ANCILLARY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 08/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N LINCOLN AVE SUITE 183
LINCOLNWOOD IL
60712
US

IV. Provider business mailing address

5630 LYONS
MORTON GROVE IL
60053
US

V. Phone/Fax

Practice location:
  • Phone: 708-937-8125
  • Fax: 847-674-0892
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ISSAM MAATOUK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-810-9095