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General NPI Number Information
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NPI Number | 1619320983
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Entity Type | Organization
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Legal Business Name | 5 PILLARS S.C.
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 404 W IRVING PARK RD
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City | WOOD DALE
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State | IL
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Zip | 60191-1343
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Country | US
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Telephone | 773-544-5306
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Fax |
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Provider Business Mailing Address
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Address Line | 4579 N MULLIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3025
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Country | US
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Telephone | 773-544-5306
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NAAZ AZIZ
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Credential | MD
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Telephone | 773-544-5306
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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 | 036127587
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License Number State | IL
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