Healthcare Provider Details

I. General information

NPI: 1194044743
Provider Name (Legal Business Name): PROSPECT HEALTHCARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 E 22ND ST SUITE 110
LOMBARD IL
60148-6106
US

IV. Provider business mailing address

2 E 22ND ST STE 215
LOMBARD IL
60148-6125
US

V. Phone/Fax

Practice location:
  • Phone: 630-376-6317
  • Fax: 630-376-6319
Mailing address:
  • Phone: 630-376-6317
  • Fax: 630-376-6319

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 Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMMAD A TOOR
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 815-722-8106