Provider Demographics
NPI:1336450386
Name:FAMILY PHYSICAL MEDICINE CORP
Entity Type:Organization
Organization Name:FAMILY PHYSICAL MEDICINE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALLAHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:630-863-5707
Mailing Address - Street 1:281 E WRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-2626
Mailing Address - Country:US
Mailing Address - Phone:708-991-9002
Mailing Address - Fax:708-991-9003
Practice Address - Street 1:2182 GLADSTONE CT
Practice Address - Street 2:SUITE B
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1517
Practice Address - Country:US
Practice Address - Phone:708-991-9002
Practice Address - Fax:708-991-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000337172P00000X
IL036114338208D00000X
IL070013531225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty