Healthcare Provider Details

I. General information

NPI: 1053683474
Provider Name (Legal Business Name): COMPREHENSIVE HEALTHCARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BROADWAY ST LOWER LEVEL
PEKIN IL
61554-3905
US

IV. Provider business mailing address

2401 BROADWAY ST LOWER LEVEL
PEKIN IL
61554-3905
US

V. Phone/Fax

Practice location:
  • Phone: 309-349-3175
  • Fax: 309-620-8751
Mailing address:
  • Phone: 309-349-3175
  • Fax: 309-620-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number136127585
License Number StateIL

VIII. Authorized Official

Name: DR. JAMALUDDIN F AMANULLAH
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 309-349-3175