MEDICARE: NORTHWEST HEALTH CARE, LTD

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	261Q00000X	Clinic/Center		IL

General Provider Information

NPI Number	:	1639260870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST HEALTH CARE, LTD

Provider Business Mailing Address
First Line	:	8642 W BERWYN AVE UNIT 2N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-2432
Country	:	US
Telephone Number	:	773-353-5047
Fax Number	:

Provider Business Practice Location Address
First Line	:	4958 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2640
Country	:	US
Telephone Number	:	773-353-5047
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMMAD KHAMIS
Credential	:	MD
Telephone Number	:	773-353-5047

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/22/2020

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