Basic Information
| Provider Information | |||||||||
| NPI: | 1972875649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FMK MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2432 | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604621089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154366814 | ||||||||
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| Practice Location | |||||||||
| Address1: | 333 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604358200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157257133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2012 | ||||||||
| LastUpdateDate: | 01/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | KAREEM | ||||||||
| AuthorizedOfficialFirstName: | FOLASHADE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7083077947 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.