Healthcare Provider Details

I. General information

NPI: 1295568640
Provider Name (Legal Business Name): FATIMETOU TEKROUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9115 S CICERO AVE STE 200
OAK LAWN IL
60453-1771
US

IV. Provider business mailing address

5113 S HARPER AVE STE 2C
CHICAGO IL
60615-4119
US

V. Phone/Fax

Practice location:
  • Phone: 773-449-0859
  • Fax: 708-398-8155
Mailing address:
  • Phone: 773-449-0859
  • Fax: 708-398-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: