Provider Demographics
NPI:1790053643
Name:LOCKPORT EXPRESS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:LOCKPORT EXPRESS MEDICAL GROUP, INC.
Other - Org Name:LOCKPORT EXPRESS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGUI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-960-1658
Mailing Address - Street 1:16221 W. 159TH STREET
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-7959
Mailing Address - Country:US
Mailing Address - Phone:815-588-1111
Mailing Address - Fax:815-838-4305
Practice Address - Street 1:16221 W. 159TH STREET
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-7959
Practice Address - Country:US
Practice Address - Phone:815-588-1111
Practice Address - Fax:815-838-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care