=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598351785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONLYMED LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2020
-----------------------------------------------------
Last Update Date | 03/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 N ELM ST STE 328
-----------------------------------------------------
City | HINSDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60521-3642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-228-9777
-----------------------------------------------------
Fax | 312-500-1843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 53 SHEFFIELD LN
-----------------------------------------------------
City | OAK BROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60523-2353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-645-6029
-----------------------------------------------------
Fax | 312-500-1843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DO
-----------------------------------------------------
Name | DR. BISHARA ROBERT KHOURY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 331-645-6029
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------