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General NPI Number Information
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NPI Number | 1659130359
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Entity Type | Organization
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Legal Business Name | AXESS CLINIC AND DIAGNOSTICS LLC
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Dates
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Enumeration Date | 03/15/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 6141 W TOUHY AVE STE B
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City | CHICAGO
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State | IL
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Zip | 60646-1268
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Country | US
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Telephone | 708-669-7175
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Fax | 312-312-7151
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Provider Business Mailing Address
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Address Line | 10176 W 400 N STE A
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-9009
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Country | US
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Telephone |
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Fax | 312-312-7151
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYED MOHAMMED QUADRI
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Credential | DO
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Telephone | 312-996-4020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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