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General NPI Number Information
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NPI Number | 1053107813
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Entity Type | Organization
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Legal Business Name | IMANI COMMUNITY CLINIC
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 502 W 138TH ST
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City | RIVERDALE
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State | IL
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Zip | 60827-1611
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Country | US
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Telephone | 312-763-6162
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Fax |
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Provider Business Mailing Address
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Address Line | 502 W 138TH ST
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City | RIVERDALE
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State | IL
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Zip | 60827-1611
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Country | US
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Telephone | 312-763-6162
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. JANICE MWANIKI
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Credential | MD
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Telephone | 312-763-6162
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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 |
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License Number State |
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