Provider Demographics
NPI:1376720045
Name:ILLINOIS MOBILE HOME PHYSICIANS CORP.
Entity Type:Organization
Organization Name:ILLINOIS MOBILE HOME PHYSICIANS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALAMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-448-9300
Mailing Address - Street 1:7250 W COLLEGE DR
Mailing Address - Street 2:1SW
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1151
Mailing Address - Country:US
Mailing Address - Phone:708-448-9300
Mailing Address - Fax:708-448-9380
Practice Address - Street 1:7250 W COLLEGE DR
Practice Address - Street 2:1SW
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1151
Practice Address - Country:US
Practice Address - Phone:708-448-9300
Practice Address - Fax:708-448-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty