Organization Name: | INTEGRATED HEALTH CARE PROVIDERS LLC |
NPI Number: | 1720353394 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUKSANA NAZNEEN (MEDICAL DIRECTOR) |
Mailing Address: | 18w511 Roosevelt Rd Lombard |
State: | IL US |
Postal Code: | 601484184 |
Phone Number: | 6302360900 |
Fax Number: | 6309534502 |
NPI Enumeration Date: | 03/15/2012 |
NPI Last Update Date: | 01/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |