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General NPI Number Information
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NPI Number | 1497792840
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Entity Type | Organization
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Legal Business Name | EDM CONSULTANT SERVICES LTD
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 675 W NORTH AVE STE 104
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City | MELROSE PARK
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State | IL
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Zip | 60160
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Country | US
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Telephone | 708-681-7695
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Fax | 708-345-7112
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Provider Business Mailing Address
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Address Line | 675 W NORTH AVE STE 104
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City | MELROSE PARK
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State | IL
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Zip | 60160
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Country | US
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Telephone | 708-681-7695
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Fax | 708-345-7112
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Authorized Official
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Title or Position | MD
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Name | DR. RIM JOUBRAN
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Credential | MD
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Telephone | 708-681-7695
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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 | 36091925
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License Number State | IL
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