Healthcare Provider Details

I. General information

NPI: 1811196389
Provider Name (Legal Business Name): FAMILY DOCTOR LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 KIRCHOFF RD
ROLLING MEADOWS IL
60008-1842
US

IV. Provider business mailing address

3433 KIRCHOFF RD
ROLLING MEADOWS IL
60008-1842
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-0095
  • Fax: 847-255-0559
Mailing address:
  • Phone: 847-255-0095
  • Fax: 847-255-0559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ARVIND K. GOYAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-255-0095