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General NPI Number Information
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NPI Number | 1831337401
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Entity Type | Organization
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Legal Business Name | FAMINAMED HEALTHCARE PROVIDERS SC
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 02/28/2009
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Provider Practice Location Address
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Address Line | 5021 CAROL ST 1F
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City | SKOKIE
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State | IL
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Zip | 60077-2202
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Country | US
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Telephone | 312-590-8742
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Fax |
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Provider Business Mailing Address
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Address Line | 5021 CAROL ST 1F
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City | SKOKIE
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State | IL
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Zip | 60077-2202
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Country | US
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Telephone | 312-590-8742
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FAROOQ AHMED
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Credential |
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Telephone | 312-590-8742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 036-118695
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License Number State | IL
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