# KISHWAUKEE INTERNIST SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568651974
- **Authorized official:** MRS. NAUSHEEN ASMA KHAN (OFFICE MANAGER)
- **Authorized official phone:** (815) 754-0300

## Contact information

- **Practice address:** 2535 BETHANY RD, SUITE 201, SYCAMORE, IL 60178-3126
- **Practice address phone:** (815) 754-0300
- **Practice address fax:** (815) 754-0400
- **Mailing address:** 2535 BETHANY RD, SUITE 201, SYCAMORE, IL 60178-3126
- **Mailing address phone:** (815) 754-0300
- **Mailing address fax:** (815) 754-0400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | IL | Yes |

## Other

- **Enumeration date:** 10/22/2007
- **Last updated:** 10/22/2007