Organization
CLINIC 1, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KASHIF M RIAZ (CEO)
(773) 996-0919
Entity
Organization
Contact information
Practice address
4759 N KEDZIE AVE, SUITE 100, CHICAGO, IL 60625-4420
(773) 685-9900
(773) 685-9910
Mailing address
5901 N CICERO AVE, SUITE 400, CHICAGO, IL 60646-5717
(773) 685-9900
(773) 685-9910
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
2085B0100X
Body Imaging Physician
—
—
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/14/2015
Last updated
08/14/2015
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