Healthcare Provider Details

I. General information

NPI: 1083078463
Provider Name (Legal Business Name): F.C HOOSEKI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 AUBURN LN
NORTHBROOK IL
60062-6934
US

IV. Provider business mailing address

2412 AUBURN LN
NORTHBROOK IL
60062-6934
US

V. Phone/Fax

Practice location:
  • Phone: 312-593-4185
  • Fax:
Mailing address:
  • Phone: 312-593-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. CHEIKH LAM
Title or Position: COO
Credential:
Phone: 312-593-4185