Organization
PURE MEDICAL GROUP LLC
Active
Organization
PURE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAJAHATUDDIN MACCI (CFO)
(773) 817-5928
Entity
Organization
Contact information
Practice address
343 N WOOD DALE RD STE 201, WOOD DALE, IL 60191-1565
(773) 817-5928
Mailing address
343 N WOOD DALE RD STE 201, WOOD DALE, IL 60191-1565
(773) 817-5928
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103K00000X
Behavior Analyst
—
—
251300000X
Local Education Agency (LEA)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/28/2022
Last updated
09/29/2022
Update your record
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