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General NPI Number Information
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NPI Number | 1629790043
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Entity Type | Organization
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Legal Business Name | EMESSA CONSULT LLC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 4836 MAIN ST
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City | SKOKIE
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State | IL
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Zip | 60077-2594
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Country | US
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Telephone | 360-492-4936
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Fax |
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Provider Business Mailing Address
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Address Line | 4836 MAIN ST
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City | SKOKIE
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State | IL
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Zip | 60077-2594
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Country | US
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Telephone | 360-492-4936
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AHMED RADWAN
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Credential |
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Telephone | 630-242-0450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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