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NPI Code Detail

MEDICARE: MINIMALLY INVASIVE THERAPY PARTNERS S.C.

MEDICARE: MINIMALLY INVASIVE THERAPY PARTNERS S.C.
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
1261QR0208XMobile Radiology Clinic/Center
2261QI0500XInfusion Therapy Clinic/Center
3261QM2500XMedical Specialty Clinic/Center
4335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
5261QR0200XRadiology Clinic/Center

General Provider Information

NPI Number : 1053659052
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINIMALLY INVASIVE THERAPY PARTNERS S.C.
Provider Business Mailing Address
First Line : 5011 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-6351
Country : US
Telephone Number : 844-834-6362
Fax Number : 708-489-7989
Provider Business Practice Location Address
First Line : 660 W WAYMAN ST
Second Line : UNIT 204 B
City : CHICAGO
State : IL
Zip : 60661-1296
Country : US
Telephone Number : 844-834-6362
Fax Number : 855-497-2932
Authorized Official
Title or Position : PRESIDENT
Name : DR. IFTIKHAR AHMAD
Credential : M.D.
Telephone Number : 844-834-6362
Provider Enumeration Date : 01/25/2013
Last Update Date : 11/17/2016

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Directions to “MINIMALLY INVASIVE THERAPY PARTNERS S.C. ” Practice Location

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