Provider Demographics
NPI:1609949890
Name:FAMILY MEDICAL & SURGICAL PRACTICE, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL & SURGICAL PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:OSMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD FRCS
Authorized Official - Phone:815-562-4500
Mailing Address - Street 1:1212 CURRENCY CT
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-2321
Mailing Address - Country:US
Mailing Address - Phone:815-562-4500
Mailing Address - Fax:815-562-5151
Practice Address - Street 1:1212 CURRENCY CT
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:IL
Practice Address - Zip Code:61068-2321
Practice Address - Country:US
Practice Address - Phone:815-562-4500
Practice Address - Fax:815-562-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208332Medicare ID - Type Unspecified
ILK04139Medicare ID - Type Unspecified
ILF23524Medicare UPIN