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General NPI Number Information
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NPI Number | 1558600106
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE THERAPY SPECIALISTS SC
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 10/18/2018
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Provider Practice Location Address
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Address Line | 5011 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-6351
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Country | US
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Telephone | 844-646-8763
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Fax | 855-497-2932
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Provider Business Mailing Address
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Address Line | 5011 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60625-6351
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Country | US
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Telephone | 844-646-8763
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Fax | 855-497-2932
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. IFTIKHAR AHMAD
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Credential | MD
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Telephone | 844-646-8763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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