Provider Demographics
NPI:1053683474
Name:COMPREHENSIVE HEALTHCARE, PC
Entity Type:Organization
Organization Name:COMPREHENSIVE HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMALUDDIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:AMANULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-349-3175
Mailing Address - Street 1:2401 BROADWAY ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3905
Mailing Address - Country:US
Mailing Address - Phone:309-349-3175
Mailing Address - Fax:309-620-8751
Practice Address - Street 1:2401 BROADWAY ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3905
Practice Address - Country:US
Practice Address - Phone:309-349-3175
Practice Address - Fax:309-620-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL136127585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI07048Medicare UPIN
IL431681957Medicare PIN