Provider Demographics
NPI:1043613581
Name:MDOC PC
Entity Type:Organization
Organization Name:MDOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHTESHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-381-5171
Mailing Address - Street 1:1250 S GROVE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5091
Mailing Address - Country:US
Mailing Address - Phone:847-381-5171
Mailing Address - Fax:847-382-1787
Practice Address - Street 1:1250 S GROVE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5091
Practice Address - Country:US
Practice Address - Phone:847-381-5171
Practice Address - Fax:847-382-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty