Provider Demographics
NPI:1811196389
Name:FAMILY DOCTOR LTD
Entity Type:Organization
Organization Name:FAMILY DOCTOR LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-255-0095
Mailing Address - Street 1:3433 KIRCHOFF RD
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1842
Mailing Address - Country:US
Mailing Address - Phone:847-255-0095
Mailing Address - Fax:847-255-0559
Practice Address - Street 1:3433 KIRCHOFF RD
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1842
Practice Address - Country:US
Practice Address - Phone:847-255-0095
Practice Address - Fax:847-255-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1447377270OtherINDIVIDUAL NPI
ILD13197Medicare UPIN
IL1447377270OtherINDIVIDUAL NPI