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General NPI Number Information
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NPI Number | 1891733507
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Entity Type | Organization
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Legal Business Name | FAMILY MED CARE CENTER SC
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 3900 W 95TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-1922
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Country | US
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Telephone | 708-423-3242
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Fax | 708-423-2856
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Provider Business Mailing Address
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Address Line | 3360 W 95TH ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2236
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Country | US
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Telephone | 708-423-3242
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Fax | 708-423-2856
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. SUMAN SETIA
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Credential | M.D.
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Telephone | 708-423-3242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036091885
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License Number State | IL
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