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General NPI Number Information
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NPI Number | 1174609226
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL ASSOCIATES, SC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 1107 N. PROSPECT AVE SUITE 100
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City | ITASCA
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State | IL
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Zip | 60143-1408
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Country | US
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Telephone | 630-467-0101
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Fax | 630-467-0707
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Provider Business Mailing Address
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Address Line | 1107 N. PROSPECT AVE SUITE 100
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City | ITASCA
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State | IL
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Zip | 60143-1408
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Country | US
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Telephone | 630-467-0101
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Fax | 630-467-0707
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Authorized Official
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Title or Position | PATIENT ACCOUNT REPRESENTATIVE
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Name | MRS. SHITAL PATEL
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Credential |
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Telephone | 630-467-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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