Organization
HEALTH CARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANA MALIK (NURSE PRACTITIONER)
(773) 988-0428
Entity
Organization
Contact information
Practice address
1000 OGDEN AVE, DOWNERS GROVE, IL 60515-2803
(331) 777-8282
Mailing address
1S125 INGERSOLL LN, VILLA PARK, IL 60181-3620
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
041.331241
IL
261QH0100X
Health Service Clinic/Center
Primary
209.006425
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1932252137
NPI
—
Enumeration date
03/07/2014
Last updated
03/07/2014
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