=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700581055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMK HEALTH SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2023
-----------------------------------------------------
Last Update Date | 04/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 242 N YORK ST # 505
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-497-0679
-----------------------------------------------------
Fax | 857-270-7320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 242 N YORK ST # 505
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-497-0679
-----------------------------------------------------
Fax | 857-270-7320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SAAD KHAN
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 847-497-0679
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------