Provider Demographics
NPI:1053659052
Name:MINIMALLY INVASIVE THERAPY PARTNERS S.C.
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE THERAPY PARTNERS S.C.
Other - Org Name:MOBILE INTERVENTION AND DIAGNOSTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IFTIKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-834-6362
Mailing Address - Street 1:5011 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6351
Mailing Address - Country:US
Mailing Address - Phone:844-834-6362
Mailing Address - Fax:708-489-7989
Practice Address - Street 1:660 W WAYMAN ST
Practice Address - Street 2:UNIT 204 B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1296
Practice Address - Country:US
Practice Address - Phone:844-834-6362
Practice Address - Fax:855-497-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile