Healthcare Provider Details

I. General information

NPI: 1245973064
Provider Name (Legal Business Name): 360 IMMEDIATE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E BUSSE AVE
MOUNT PROSPECT IL
60056-3215
US

IV. Provider business mailing address

70 E BUSSE AVE
MOUNT PROSPECT IL
60056-3215
US

V. Phone/Fax

Practice location:
  • Phone: 847-749-4408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GULE TALHA
Title or Position: PRESIDENT
Credential:
Phone: 847-749-4408