| Illinois Medical Care Ltd | |
|
5025 N Paulina St Chicago IL 60640-2772 | |
| (773) 931-8082 | |
| (888) 847-9526 |
| Full Name | Illinois Medical Care Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 5025 N Paulina St, Chicago, Illinois |
| Authorized Official Name and Position | Maher Al-koubaytari (PRESIDENT) |
| Authorized Official Contact | 7739318082 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Illinois Medical Care Ltd 1721 Greendale Ave Park Ridge IL 60068-1926 Ph: (773) 931-8082 | Illinois Medical Care Ltd 5025 N Paulina St Chicago IL 60640-2772 Ph: (773) 931-8082 |
| NPI Number | 1508980889 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 01/30/2018 |
| Medicare PECOS PAC ID | 9638155690 |
|---|---|
| Medicare Enrollment ID | O20040629000793 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508980889 | NPI | - | NPPES |
| 036094781 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036094781 (Illinois) | Primary |
| Provider Name | Maher Al-koubaytari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437124419 PECOS PAC ID: 2860478856 Enrollment ID: I20040629001028 |
| Provider Name | Jay Declarador |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417460502 PECOS PAC ID: 8921367103 Enrollment ID: I20180116000439 |
| Provider Name | Mohamed I Jabri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013026004 PECOS PAC ID: 1557366242 Enrollment ID: I20210503000027 |
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