Provider Demographics
NPI:1851839575
Name:KAMAL, ASIM (LAC)
Entity Type:Individual
Prefix:MR
First Name:ASIM
Middle Name:
Last Name:KAMAL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9360 KESWICK DR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7682
Mailing Address - Country:US
Mailing Address - Phone:630-686-2280
Mailing Address - Fax:
Practice Address - Street 1:9360 KESWICK DR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-7682
Practice Address - Country:US
Practice Address - Phone:630-686-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000192A.171100000X
IL198001353171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist