Organization
INTERNAL MEDICINE AND FAMILY PHYSICIANS, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMIULLAH M CHOUDRY M.D. (PRESIDENT)
(815) 773-0099
Entity
Organization
Contact information
Practice address
1051 ESSINGTON RD, SUITE 290, JOLIET, IL 60435-2801
(815) 773-0099
(815) 773-0088
Mailing address
1051 ESSINGTON ROAD, SUITE 290, JOLIET, IL 60435-2842
(815) 773-0099
(815) 773-0088
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-105476
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009932044
BCBS
IL
05
—
036105476
—
IL
Enumeration date
09/02/2006
Last updated
06/14/2010
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