Organization
OPTIMUM PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHALED A REHEEM-FARAG MD (PRESIDENT)
(773) 841-9238
Entity
Organization
Contact information
Practice address
7330 INDIANAPOLIS BLVD, HAMMOND, IN 46324-2941
(219) 844-1444
Mailing address
11116 SARATOGA DR, ORLAND PARK, IL 60467-8740
(773) 841-9238
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01059379A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL2028
PTAN
IL
Enumeration date
05/18/2009
Last updated
03/28/2011
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