Organization
NORTHWEST MEDICAL AND URGENT CARE CENTER AT MADISON LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD KHAMIS MD (PRESIDENT/CEO)
(773) 362-4648
Entity
Organization
Contact information
Practice address
3171 W MADISON ST, CHICAGO, IL 60612-1809
(773) 362-4648
Mailing address
5352 N LINCOLN AVE, CHICAGO, IL 60625-2316
(773) 353-5047
(773) 353-2406
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112029
—
IL
Enumeration date
11/10/2017
Last updated
10/24/2018
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