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General NPI Number Information
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NPI Number | 1356664833
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Entity Type | Organization
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Legal Business Name | JFA MEDICAL GROUP SC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 732 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60624-4058
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Country | US
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Telephone | 773-533-1621
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Fax |
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Provider Business Mailing Address
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Address Line | 211 SOMERSET RD
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5430
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Country | US
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Telephone | 630-455-5531
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHAMMED J ALI
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Credential | M.D.
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Telephone | 773-533-1621
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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 | 036062868
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License Number State | IL
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