Healthcare Provider Details

I. General information

NPI: 1366294811
Provider Name (Legal Business Name): GEMINI HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9150 CRAWFORD AVE STE L-6
SKOKIE IL
60076-1700
US

IV. Provider business mailing address

9150 CRAWFORD AVE STE L-6
SKOKIE IL
60076-1700
US

V. Phone/Fax

Practice location:
  • Phone: 224-341-5331
  • Fax: 224-341-7538
Mailing address:
  • Phone: 224-341-5331
  • Fax: 224-341-7538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: FNU MOHAMMED MUQTADIR
Title or Position: PRESIDENT
Credential:
Phone: 224-341-5331