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General NPI Number Information
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NPI Number | 1356553036
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Entity Type | Organization
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Legal Business Name | ONE MAG MILE ASSOCIATES, INC.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11012 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643
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Country | US
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Telephone | 773-238-5300
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Fax | 773-238-5343
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Provider Business Mailing Address
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Address Line | 950 N MICHIGAN AVE SUITE 4305
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City | CHICAGO
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State | IL
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Zip | 60611-4509
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Country | US
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Telephone | 312-587-9123
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Fax | 312-944-4954
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BHAGWAN T SHAHANI
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Credential | M.D.
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Telephone | 312-587-9123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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