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General NPI Number Information
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NPI Number | 1174346415
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Entity Type | Organization
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Legal Business Name | SALLY HEALTH & INNOVATIVE PARTNERS
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 5604 W SUTTON PL UNIT A
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City | MONEE
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State | IL
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Zip | 60449-8131
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Country | US
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Telephone | 312-802-9646
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 W MAIN ST # 2
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City | MONEE
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State | IL
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Zip | 60449-8101
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Country | US
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Telephone | 312-802-9646
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Fax |
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Authorized Official
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Title or Position | MD/CEO
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Name | ISHMAEL AMU
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Credential | MD
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Telephone | 312-802-9646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744R1102X
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Taxonomy Name | Research Study Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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