Healthcare Provider Details

I. General information

NPI: 1366483729
Provider Name (Legal Business Name): ANN MEDICAL CENTER SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 LINCOLN HWY
MATTESON IL
60443-2319
US

IV. Provider business mailing address

PO BOX 250
MATTESON IL
60443-0250
US

V. Phone/Fax

Practice location:
  • Phone: 708-747-7720
  • Fax: 708-915-7239
Mailing address:
  • Phone: 708-747-5850
  • Fax: 708-747-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-051648
License Number StateIL

VIII. Authorized Official

Name: ANJUM HAMEEDUDDIN
Title or Position: OWNER
Credential: M.D.
Phone: 708-747-7720