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General NPI Number Information
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NPI Number | 1831358183
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Entity Type | Organization
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Legal Business Name | CRIMSON ARK MEDICAL SERVICES, INC.
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 516 S FAIRVIEW AVE
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City | ELMHURST
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State | IL
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Zip | 60126-3731
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Country | US
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Telephone | 630-254-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 386 N YORK RD STE 100
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City | ELMHURST
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State | IL
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Zip | 60126-2363
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Country | US
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Telephone | 630-758-0630
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Fax | 630-758-0632
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Authorized Official
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Title or Position | OWNER
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Name | DR. JITENDRA KUMAR MOHINDRA
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Credential |
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Telephone | 630-758-0630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036089371
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License Number State | IL
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