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General NPI Number Information
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NPI Number | 1508980889
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Entity Type | Organization
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Legal Business Name | ILLINOIS MEDICAL CARE LTD
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 5025 N PAULINA ST
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City | CHICAGO
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State | IL
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Zip | 60640-2772
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Country | US
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Telephone | 773-931-8082
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Fax | 888-847-9526
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Provider Business Mailing Address
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Address Line | 1721 GREENDALE AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-1926
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Country | US
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Telephone | 773-931-8082
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Fax | 888-847-9526
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHER AL-KOUBAYTARI
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Credential | MD
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Telephone | 773-931-8082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036094781
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License Number State | IL
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