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General NPI Number Information
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NPI Number | 1295438471
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Entity Type | Organization
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Legal Business Name | SOUL TAB LLC
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 2300 BARRINGTON RD STE 497
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-2082
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Country | US
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Telephone | 630-936-9062
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Fax |
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Provider Business Mailing Address
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Address Line | 721 BLUE RIDGE DR
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City | STREAMWOOD
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State | IL
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Zip | 60107-4503
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Country | US
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Telephone | 630-936-9062
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BALJIT SINGH
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Credential |
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Telephone | 630-936-9062
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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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