MEDICARE: JSK FAMILY HEALTHCARE, P.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
1	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1902976368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JSK FAMILY HEALTHCARE, P.C

Provider Business Mailing Address
First Line	:	1557 BLOOMINGDALE RD
Second Line	:	SUITE 1200
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2733
Country	:	US
Telephone Number	:	630-681-7566
Fax Number	:	630-681-7568

Provider Business Practice Location Address
First Line	:	1557 BLOOMINGDALE RD
Second Line	:	SUITE 1200
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-2733
Country	:	US
Telephone Number	:	630-681-7566
Fax Number	:	630-681-7568

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOHAMMED RIAZUDDIN
Credential	:	M.D
Telephone Number	:	630-681-7566

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/22/2020

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