Provider Demographics
NPI:1558600106
Name:MINIMALLY INVASIVE THERAPY SPECIALISTS SC
Entity Type:Organization
Organization Name:MINIMALLY INVASIVE THERAPY SPECIALISTS SC
Other - Org Name:MITS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:IFTIKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-646-8763
Mailing Address - Street 1:5011 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6351
Mailing Address - Country:US
Mailing Address - Phone:844-646-8763
Mailing Address - Fax:855-497-2932
Practice Address - Street 1:5011 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6351
Practice Address - Country:US
Practice Address - Phone:844-646-8763
Practice Address - Fax:855-497-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8727OtherGROUP PTAN
IL1922070457OtherINDIVIDUAL NPI
IL068824647OtherINDIVIDUAL MEDICAID PROVIDER
IL1558600106OtherGROUP NPI
IL027928G89OtherINDIVIDUAL MEDICARE PTAN
IL=========OtherGROUP MEDICAID PROVIDER
IL027928G89Medicare PIN
IL=========OtherGROUP MEDICAID PROVIDER