# NORTHWEST MEDICAL AND URGENT CARE CENTER AT MADISON LTD

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

## Provider details

- **NPI number:** 1881107902
- **Authorized official:** DR. MOHAMMAD KHAMIS MD (PRESIDENT/CEO)
- **Authorized official phone:** (773) 362-4648

## Contact information

- **Practice address:** 3171 W MADISON ST, CHICAGO, IL 60612-1809
- **Practice address phone:** (773) 362-4648
- **Mailing address:** 5352 N LINCOLN AVE, CHICAGO, IL 60625-2316
- **Mailing address phone:** (773) 353-5047
- **Mailing address fax:** (773) 353-2406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/10/2017
- **Last updated:** 10/24/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036112029 | — | IL |