Healthcare Provider Details

I. General information

NPI: 1639128200
Provider Name (Legal Business Name): EMPLOYEE HEALTH ADVOCATE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26241 W BONNER RD
WAUCONDA IL
60084-3211
US

IV. Provider business mailing address

PO BOX 74
FOX RIVER GROVE IL
60021-0074
US

V. Phone/Fax

Practice location:
  • Phone: 847-358-7468
  • Fax: 847-358-2808
Mailing address:
  • Phone: 847-358-7468
  • Fax: 847-358-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: RASHEED SOOFI
Title or Position: CEO
Credential: MD
Phone: 847-358-7468