Basic Information
| Provider Information | |||||||||
| NPI: | 1104812742 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRESCENT PRIMARY CARE PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2132 DEEP WATER LN | ||||||||
| Address2: | STE 228 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605648498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309221400 | ||||||||
| FaxNumber: | 6309047378 | ||||||||
| Practice Location | |||||||||
| Address1: | 2132 DEEP WATER LN | ||||||||
| Address2: | STE 228 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605648498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309221400 | ||||||||
| FaxNumber: | 6309047378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GHOUSE | ||||||||
| AuthorizedOfficialFirstName: | FOWZIA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6309221400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.