Organization
INFINITUS CORPORATION
Active
Organization
INFINITUS CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOQUEET SYED (CREDENTIALING MANAGER)
(630) 440-7786
Entity
Organization
Contact information
Practice address
333 N RANDALL RD, SUITE 140, ST CHARLES, IL 60174-1500
(800) 356-3627
Mailing address
333 N RANDALL RD, SUITE 140, ST CHARLES, IL 60174-1500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036108385
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036108385
LICENSE NUMBER
IL
01
—
336069152
CONTROLLED SUBSTANCE LICENSE
IL
Enumeration date
06/04/2015
Last updated
06/04/2015
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