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General NPI Number Information
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NPI Number | 1972926145
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Entity Type | Organization
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Legal Business Name | SELAH MEDICAL GROUP S.C
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 927 N PLUM GROVE RD
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City | SCHAUMBURG
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State | IL
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Zip | 60173-5171
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Country | US
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Telephone | 630-945-7797
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Fax |
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Provider Business Mailing Address
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Address Line | 4160 WILLIAMS CT
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60192-1407
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Country | US
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Telephone | 630-945-7797
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/CEO
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Name | DR. VICTOR OLAWALE MENSAH
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Credential | M.D
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Telephone | 630-945-7797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 036-116775
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License Number State | IL
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