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General NPI Number Information
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NPI Number | 1295522688
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Entity Type | Organization
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Legal Business Name | AVID PRIMARY CARE LLC
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 9965 W 151ST ST
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City | ORLAND PARK
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State | IL
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Zip | 60462-3113
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Country | US
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Telephone | 708-887-7329
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Fax | 708-786-0066
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Provider Business Mailing Address
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Address Line | 9965 W 151ST ST
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City | ORLAND PARK
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State | IL
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Zip | 60462-3113
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Country | US
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Telephone | 708-887-7329
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Fax | 708-786-0066
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Authorized Official
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Title or Position | AUTHORIZE OFFICIAL
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Name | ASHRAF ANANI
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Credential |
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Telephone | 708-887-7329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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