Endocrine Diabetes Clinic LTD

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

036093254 Issued in IL

Legal business name

ENDOCRINE DIABETES CLINIC LTD

Practice address

3830 W 95TH St
Evergreen Park, IL 60805-2004

Phone

(708) 479-6522

NPI assigned

Mar 14, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Abdallah Altarshan, MD

Title

President

Phone

(708) 479-6522

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363219200000",
    "number": "1598006546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 W 95TH ST",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052004",
            "telephone_number": "708-479-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 W 95TH ST",
            "city": "EVERGREEN PARK",
            "state": "IL",
            "postal_code": "608052004",
            "telephone_number": "708-479-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDOCRINE DIABETES CLINIC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-14",
        "last_updated": "2013-03-14",
        "status": "A",
        "authorized_official_last_name": "ALTARSHAN",
        "authorized_official_first_name": "ABDALLAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-479-6522",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "IL",
            "license": "036093254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036093254",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krystle Ekhoff, RN, IBCLC
• Ellen M Hennecke Dosc
• John Robert Elsen, M.D.
• John C Elser, M.D.
• Haley Suzanne Elson, LCSW
• Englewood Community Outreach
• Catherine Veronica Espinosa, APRN
• Charmaine Boncalon Espiritu
• Alfred W Evans Jr., R.PH
• Evergrace Therapy LLC

• Endocrinology, Diabetes & Metabolism Physician in Evergreen Park, IL
• Providers in Evergreen Park, IL by specialty
• Endocrinology, Diabetes & Metabolism Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; 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.