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General NPI Number Information
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NPI Number | 1043564529
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Entity Type | Organization
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Legal Business Name | TRIPLE S MEDICAL CARE S.C.
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 6455 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629
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Country | US
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Telephone | 773-735-3456
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Fax | 773-735-3279
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Provider Business Mailing Address
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Address Line | 8428 ARROWHEAD FARM DR
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City | BURR RIDGE
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State | IL
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Zip | 60527-0822
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOUSRY GIRGIS SR.
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Credential | M.D.
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Telephone | 331-425-2374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036.129213
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License Number State | IL
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