Provider Demographics
NPI:1215407812
Name:ILLINOIS URGENT CARE PROFESSIONALS PLLC
Entity Type:Organization
Organization Name:ILLINOIS URGENT CARE PROFESSIONALS PLLC
Other - Org Name:ON DMED URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NOORUN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-933-9200
Mailing Address - Street 1:17960 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2014
Mailing Address - Country:US
Mailing Address - Phone:847-933-9200
Mailing Address - Fax:773-439-7715
Practice Address - Street 1:17960 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2014
Practice Address - Country:US
Practice Address - Phone:847-933-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care