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General NPI Number Information
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NPI Number | 1083124465
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Entity Type | Organization
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Legal Business Name | ACADEMIC RHEUMATOLOGY LLC
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 13303 S RIDGELAND AVE UNIT C
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-0020
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Country | US
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Telephone | 708-401-3311
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Fax | 708-401-3131
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Provider Business Mailing Address
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Address Line | 22017 EMILY LN
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City | FRANKFORT
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State | IL
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Zip | 60423-7817
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Country | US
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Telephone | 708-401-3311
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Fax | 708-401-3131
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Authorized Official
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Title or Position | PRESIDENT
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Name | IBRAHIM ALGHAFEER
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Credential | M.D
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Telephone | 708-401-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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