Provider Demographics
NPI:1083855811
Name:GHANI MEDICAL CENTER, MD SC
Entity Type:Organization
Organization Name:GHANI MEDICAL CENTER, MD SC
Other - Org Name:ALLERGY & CL IMMUNOLOGY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-344-3550
Mailing Address - Street 1:10001 W ROOSEVELT RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2664
Mailing Address - Country:US
Mailing Address - Phone:708-344-3550
Mailing Address - Fax:708-344-6577
Practice Address - Street 1:7808 W COLLEGE DR
Practice Address - Street 2:SUITE 1SW
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1027
Practice Address - Country:US
Practice Address - Phone:708-361-0730
Practice Address - Fax:708-361-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-050567207RA0201X
IL085-001419207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216213036OtherBC/BS
IL6046301Medicaid
IL217113Medicare PIN