Optimum Primary Care Llc | |
7330 Indianapolis Blvd Hammond IN 46324-2941 | |
(219) 844-1444 | |
Not Available |
Full Name | Optimum Primary Care Llc |
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Speciality | Internal Medicine |
Location | 7330 Indianapolis Blvd, Hammond, Indiana |
Authorized Official Name and Position | Khaled A Reheem-farag (PRESIDENT) |
Authorized Official Contact | 7738419238 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Optimum Primary Care Llc 11116 Saratoga Dr Orland Park IL 60467-8740 Ph: (773) 841-9238 | Optimum Primary Care Llc 7330 Indianapolis Blvd Hammond IN 46324-2941 Ph: (219) 844-1444 |
NPI Number | 1073748216 |
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Provider Enumeration Date | 05/18/2009 |
Last Update Date | 03/28/2011 |
Medicare PECOS PAC ID | 4880744861 |
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Medicare Enrollment ID | O20090625000334 |
Identifier | Type | State | Issuer |
---|---|---|---|
1073748216 | NPI | - | NPPES |
IL2028 | Other | IL | PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 01059379A (Indiana) | Primary |
Provider Name | Khaled A Reheem Farag |
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Provider Type | Practitioner - Interventional Cardiology |
Provider Identifiers | NPI Number: 1811931108 PECOS PAC ID: 0143282228 Enrollment ID: I20041101000634 |
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