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NPI Code Detail

MEDICARE: INNER-CITY MUSLIM ACTION NETWORK

MEDICARE: INNER-CITY MUSLIM ACTION NETWORK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center
2101Y00000XCounselor
3261Q00000XClinic/Center
4261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1003244567
Entity Type Code : Organization
Provider Name (Legal Business Name) : INNER-CITY MUSLIM ACTION NETWORK
Provider Business Mailing Address
First Line : 2744 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-2343
Country : US
Telephone Number : 773-434-4626
Fax Number : 773-776-3623
Provider Business Practice Location Address
First Line : 2744 W 63RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-2343
Country : US
Telephone Number : 773-434-4626
Fax Number : 773-776-3623
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : RAMI NASHASHIBI
Credential : PHD
Telephone Number : 773-434-4626
Provider Enumeration Date : 10/21/2013
Last Update Date : 05/02/2018

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Directions to “INNER-CITY MUSLIM ACTION NETWORK ” Practice Location

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