Provider Demographics
NPI:1770516957
Name:ISSAN HEALTH CARE GROUP LTD
Entity type:Organization
Organization Name:ISSAN HEALTH CARE GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAZEER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-458-7170
Mailing Address - Street 1:815 N LARKIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3449
Mailing Address - Country:US
Mailing Address - Phone:815-744-7400
Mailing Address - Fax:157-447-4358
Practice Address - Street 1:815 N LARKIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3449
Practice Address - Country:US
Practice Address - Phone:815-744-7400
Practice Address - Fax:157-447-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01606583OtherBLUE CROSS BLUE SHIELD
ILDG5049OtherRAILROAD MEDICARE
IL01606583OtherBLUE CROSS BLUE SHIELD