Healthcare Provider Details

I. General information

NPI: 1750522710
Provider Name (Legal Business Name): GHANI MEDICAL CENTER, MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 W ROOSEVELT RD SUITE 304
WESTCHESTER IL
60154-2664
US

IV. Provider business mailing address

10001 W ROOSEVELT RD SUITE 304
WESTCHESTER IL
60154-2664
US

V. Phone/Fax

Practice location:
  • Phone: 708-344-3550
  • Fax: 708-344-6577
Mailing address:
  • Phone: 708-344-3550
  • Fax: 708-344-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number085-001462
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number085-001419
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number036-050567
License Number StateIL

VIII. Authorized Official

Name: NINA THOMPSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-344-3550