Provider Demographics
NPI:1508922949
Name:K QADIR SC
Entity Type:Organization
Organization Name:K QADIR SC
Other - Org Name:VALLEY GASTRO SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHURRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:QADIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-639-7771
Mailing Address - Street 1:2020 OGDEN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5894
Mailing Address - Country:US
Mailing Address - Phone:630-898-3535
Mailing Address - Fax:630-499-2452
Practice Address - Street 1:2020 OGDEN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5894
Practice Address - Country:US
Practice Address - Phone:630-499-2442
Practice Address - Fax:630-499-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36114031207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL285924555Medicaid
IL285924555Medicaid