NPIMap

Organization Active NPI

Mamanatandathernizampc.

  • Community Health Clinic/Center
  • Chicago, IL
National Provider Identifier
1104134915
Registry record updated Sep 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
036-06-9635 Issued in IL
Legal business name
MAMANATANDATHERNIZAMPC.
Practice address
2001 W.69THST.
Chicago, IL 60636
Phone
(773) 778-2355
Fax
(773) 788-2355
NPI assigned
Sep 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Maimanat Nizam, MD.NPI 1265579262
Title
Physician
Phone
(630) 654-1021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 036-06-9635 IL Primary

Addresses

Primary practice location

2001 W.69THST.
Chicago, IL 60636

Mailing address

401 Tamerton Pkwy
Burr Ridge, IL 60527-6347
Phone (630) 654-1021

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284508800000",
    "number": "1104134915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 TAMERTON PKWY",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276347",
            "telephone_number": "630-654-1021",
            "fax_number": "773-788-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 W.69THST.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60636",
            "telephone_number": "773-778-2355",
            "fax_number": "773-788-2355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAMANATANDATHERNIZAMPC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-15",
        "last_updated": "2010-09-15",
        "status": "A",
        "authorized_official_last_name": "NIZAM",
        "authorized_official_first_name": "MAIMANAT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "630-654-1021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "IL",
            "license": "036-06-9635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.