Provider Demographics
NPI:1669732582
Name:HARI OM NAMO SC
Entity type:Organization
Organization Name:HARI OM NAMO SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-312-5606
Mailing Address - Street 1:9600 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1522
Mailing Address - Country:US
Mailing Address - Phone:224-402-4496
Mailing Address - Fax:
Practice Address - Street 1:404 W IRVING PARK RD
Practice Address - Street 2:STE 3
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1343
Practice Address - Country:US
Practice Address - Phone:224-402-4496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619991302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13224Medicare UPIN
IL001668490Medicare PIN