Healthcare Provider Details

I. General information

NPI: 1215494463
Provider Name (Legal Business Name): FIRST PEEK ULTRASOUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121A NORTH AVE
OAK PARK IL
60302-1002
US

IV. Provider business mailing address

7121A NORTH AVE
OAK PARK IL
60302-1002
US

V. Phone/Fax

Practice location:
  • Phone: 972-215-8703
  • Fax:
Mailing address:
  • Phone: 972-215-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BEEZER MOOLJI
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 972-215-8703