Healthcare Provider Details

I. General information

NPI: 1811524937
Provider Name (Legal Business Name): JOUDEH MEDICAL CONSULTING LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16501 106TH CT
ORLAND PARK IL
60467-4545
US

IV. Provider business mailing address

16501 106TH CT
ORLAND PARK IL
60467-4545
US

V. Phone/Fax

Practice location:
  • Phone: 708-904-4979
  • Fax: 708-407-9006
Mailing address:
  • Phone: 708-904-4979
  • Fax: 708-407-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: YAZEN JOUDEH
Title or Position: OWNER
Credential: MD
Phone: 708-904-4979