MEDICARE: ILLINOIS PRIMARY URGENT CARE LLC

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
1	261QU0200X	Urgent Care Clinic/Center	036127590	IL
2	261QP2300X	Primary Care Clinic/Center	036127590	IL

General Provider Information

NPI Number	:	1255834446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLINOIS PRIMARY URGENT CARE LLC

Provider Business Mailing Address
First Line	:	2026 62ND ST
Second Line	:
City	:	MONMOUTH
State	:	IL
Zip	:	61462-9054
Country	:	US
Telephone Number	:	309-337-0736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 E BROADWAY STE B
Second Line	:
City	:	MONMOUTH
State	:	IL
Zip	:	61462-1995
Country	:	US
Telephone Number	:	309-337-0736
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ABDUL WAHID ROYEEN
Credential	:	MD
Telephone Number	:	309-337-0736

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	03/14/2018

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Directions to “ILLINOIS PRIMARY URGENT CARE LLC ” Practice Location

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