Provider Demographics
NPI:1750755708
Name:T CLINIC LLC
Entity type:Organization
Organization Name:T CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HASEEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-242-0600
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-0016
Mailing Address - Country:US
Mailing Address - Phone:618-242-0600
Mailing Address - Fax:
Practice Address - Street 1:4204 WILLIAMSON PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6705
Practice Address - Country:US
Practice Address - Phone:618-242-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty