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General NPI Number Information
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NPI Number | 1922333095
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Entity Type | Organization
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Legal Business Name | MOBILE DOCTORS, LLC
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 6326 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60636-2725
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Country | US
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Telephone | 773-424-0112
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Fax | 773-424-0112
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Provider Business Mailing Address
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Address Line | 6326 S ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60636-2725
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Country | US
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Telephone | 773-424-0112
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Fax | 773-424-0112
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Authorized Official
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Title or Position | OWNER
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Name | MR. MUHAMMED HUMAYOUN
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Credential |
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Telephone | 219-678-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 036.117439
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License Number State | IL
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