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General NPI Number Information
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NPI Number | 1265690291
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Entity Type | Organization
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Legal Business Name | SIBLEY FAMILY MEDICAL CENTER SC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 1756 SIBLEY BLVD
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City | CALUMET CITY
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State | IL
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Zip | 60409-2215
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Country | US
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Telephone | 708-730-3900
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Fax | 708-730-7298
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Provider Business Mailing Address
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Address Line | 1756 SIBLEY BLVD
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City | CALUMET CITY
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State | IL
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Zip | 60409-2215
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Country | US
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Telephone | 708-730-3900
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Fax | 708-730-7298
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Authorized Official
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Title or Position | OWNER
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Name | DR. SALIM KASSAM
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Credential | MD
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Telephone | 708-730-3900
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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 | 036071269
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License Number State | IL
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