Basic Information
| Provider Information | |||||||||
| NPI: | 1972928679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL MANAGEMENT GROUP SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3111 DUNDEE RD | ||||||||
| Address2: | SUITE 506 | ||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600622402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475620840 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Practice Location | |||||||||
| Address1: | 3111 DUNDEE RD | ||||||||
| Address2: | SUITE 506 | ||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600622402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475620840 | ||||||||
| FaxNumber: | 7737512250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2014 | ||||||||
| LastUpdateDate: | 03/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | AKHTER | ||||||||
| AuthorizedOfficialFirstName: | NADEEM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8475620840 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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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.