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General NPI Number Information
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NPI Number | 1609207661
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Entity Type | Organization
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Legal Business Name | BROADWAY MEDICAL CLINIC, SC
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 4009 WARREN AVE
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City | BELLWOOD
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State | IL
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Zip | 60104-2066
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Country | US
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Telephone | 708-343-1300
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Fax | 708-345-8965
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Provider Business Mailing Address
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Address Line | 947 S MANNHEIM RD
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City | WESTCHESTER
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State | IL
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Zip | 60154-2515
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AFSOON KARIMI
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Credential | M.D.
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Telephone | 708-343-1300
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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