Organization
MARYMINA RESPIRATORY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OSSAMA IKLADIOS M.D. (PRESIDENT)
(309) 360-4879
Entity
Organization
Contact information
Practice address
1740 SYCAMORE, WASHINGTON, IL 61571-9799
(309) 360-4879
Mailing address
1740 SYCAMORE, WASHINGTON, IL 61571-9799
(309) 360-4879
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
025MA069176
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8065403
—
NJ
Enumeration date
01/12/2009
Last updated
07/10/2011
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