Provider Demographics
NPI:1720263197
Name:ABK MEDICAL CENTER, LTD.
Entity Type:Organization
Organization Name:ABK MEDICAL CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDISHO
Authorized Official - Middle Name:B
Authorized Official - Last Name:KHOSHABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-728-9399
Mailing Address - Street 1:2653 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4017
Mailing Address - Country:US
Mailing Address - Phone:773-728-9399
Mailing Address - Fax:
Practice Address - Street 1:2653 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4017
Practice Address - Country:US
Practice Address - Phone:773-728-9399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty