MEDICARE: FAMILY DOCTOR 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	261QM2500X	Medical Specialty Clinic/Center		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1447377270	OTHER	IL	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1811196389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DOCTOR LTD

Provider Business Mailing Address
First Line	:	3433 KIRCHOFF RD
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1842
Country	:	US
Telephone Number	:	847-255-0095
Fax Number	:	847-255-0559

Provider Business Practice Location Address
First Line	:	3433 KIRCHOFF RD
Second Line	:
City	:	ROLLING MEADOWS
State	:	IL
Zip	:	60008-1842
Country	:	US
Telephone Number	:	847-255-0095
Fax Number	:	847-255-0559

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARVIND K. GOYAL
Credential	:	M.D.
Telephone Number	:	847-255-0095

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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Directions to “FAMILY DOCTOR LTD ” Practice Location

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