Organization
LIBERTY MEDICAL CENTER COAL CITY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HASSNAIN S SYED M.D., (DIRECTOR)
(815) 634-4099
Entity
Organization
Contact information
Practice address
4 E NORTH ST, COAL CITY, IL 60416-1087
(815) 634-4099
(815) 634-4077
Mailing address
4 E NORTH ST, COAL CITY, IL 60416-1087
(815) 634-4099
(815) 634-4077
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
03-6127143
IL
207Q00000X
Family Medicine Physician
036-118250
IL
207Q00000X
Family Medicine Physician
Primary
036-125457
IL
207R00000X
Internal Medicine Physician
036-087831
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-087831
—
IL
05
—
036-118250
—
IL
05
—
036-125457
—
IL
01
—
T01609
MEDICARE PTAN
IL
Enumeration date
06/02/2011
Last updated
06/02/2011
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