2001-15 N Parkside LLC
Clinic/Center in Chicago, IL. Organization (NPI-2).
NPI number1518607696
StatusActive
Last updated in NPPESMar 29, 2022
Details
- NPI
- 1518607696
- Entity type
- Organization (NPI-2)
- Legal business name
- 2001-15 N Parkside LLC
- Organization subpart
- No
- Enumeration date
- Mar 29, 2022
- Certification date
- Mar 29, 2022
- Last updated
- Mar 29, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | – | – | Yes |
Practice location
405 N Wabash Ave Ste P2-AChicago, IL 60611-3744
Phone 312-955-4005
Mailing address
18140 Audette StDearborn, MI 48124-4217
Phone 312-998-5229
Authorized official
Mona Khan
Physician
3129554005
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