Healthcare Provider Details

I. General information

NPI: 1174346415
Provider Name (Legal Business Name): SALLY HEALTH & INNOVATIVE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 W SUTTON PL UNIT A
MONEE IL
60449-8131
US

IV. Provider business mailing address

5410 W MAIN ST # 371
MONEE IL
60449-8101
US

V. Phone/Fax

Practice location:
  • Phone: 708-573-3663
  • Fax: 866-643-9240
Mailing address:
  • Phone: 708-573-3663
  • Fax: 866-439-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ISHMAEL AMU
Title or Position: CEO
Credential:
Phone: 708-573-3663