Healthcare Provider Details

I. General information

NPI: 1952566283
Provider Name (Legal Business Name): DOCTORS ON CALL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 INDIANAPOLIS BLVD
WHITING IN
46394-1948
US

IV. Provider business mailing address

2075 INDIANAPOLIS BLVD
WHITING IN
46394-1948
US

V. Phone/Fax

Practice location:
  • Phone: 219-659-2255
  • Fax: 708-233-1232
Mailing address:
  • Phone: 219-659-2255
  • Fax: 708-233-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036096495
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05003890A
License Number StateIN

VIII. Authorized Official

Name: MR. MOHAMED SAEED IBRAHIM
Title or Position: OWNER
Credential: LICENSE PHYSICAL TH
Phone: 219-448-0667