Organization
ENDOCRINE DIABETES CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ABDALLAH ALTARSHAN MD (PRESIDENT)
(708) 479-6522
Entity
Organization
Contact information
Practice address
3830 W 95TH ST, EVERGREEN PARK, IL 60805-2004
(708) 479-6522
Mailing address
3830 W 95TH ST, EVERGREEN PARK, IL 60805-2004
(708) 479-6522
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
036093254
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036093254
—
IL
Enumeration date
03/14/2013
Last updated
03/14/2013
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