Provider Demographics
NPI:1265690291
Name:SIBLEY FAMILY MEDICAL CENTER SC
Entity type:Organization
Organization Name:SIBLEY FAMILY MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-730-3900
Mailing Address - Street 1:1756 SIBLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-2215
Mailing Address - Country:US
Mailing Address - Phone:708-730-3900
Mailing Address - Fax:708-730-7298
Practice Address - Street 1:1756 SIBLEY BLVD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-2215
Practice Address - Country:US
Practice Address - Phone:708-730-3900
Practice Address - Fax:708-730-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071269Medicaid
IL036071269Medicaid