Organization
ENDO-MED CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WASSIM EL-HARAKE MD (PRESIDENT)
(815) 730-3304
Entity
Organization
Contact information
Practice address
2450 GLENWOOD AVE, JOLIET, IL 60435-5463
(815) 730-3304
(815) 730-3305
Mailing address
2450 GLENWOOD AVE, JOLIET, IL 60435-5463
(815) 730-3304
(815) 730-3305
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036089327
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346236098
—
IL
Enumeration date
06/14/2016
Last updated
06/14/2016
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