Provider Demographics
NPI:1710352091
Name:HARIS MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:HARIS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JABEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FATIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-847-7880
Mailing Address - Street 1:1252 OGDEN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2740
Mailing Address - Country:US
Mailing Address - Phone:630-847-7880
Mailing Address - Fax:630-559-9004
Practice Address - Street 1:240 E LAKE ST STE 102
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2873
Practice Address - Country:US
Practice Address - Phone:630-782-9780
Practice Address - Fax:630-782-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty