Liberty Medical Center of Minooka, SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LIBERTY MEDICAL CENTER OF MINOOKA, SC

Practice address

603 W Mondamin St
Minooka, IL 60447-9057

Phone

(815) 521-1010

Fax

(815) 521-1826

NPI assigned

Jan 8, 2008

Last updated

Jan 8, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Aftab A Khan, M.D.

Title

Physician

Phone

(815) 521-1010

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1639354780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 W MONDAMIN ST",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604479057",
            "telephone_number": "815-521-1010",
            "fax_number": "815-521-1826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 W MONDAMIN ST",
            "city": "MINOOKA",
            "state": "IL",
            "postal_code": "604479057",
            "telephone_number": "815-521-1010",
            "fax_number": "815-521-1826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL CENTER OF MINOOKA, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-08",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "AFTAB",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "815-521-1010",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Lara, MSW
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• Shelley A Manning
• Joann Lynn Maruszak, D.C.
• Audrey L Mascitti

• Family Medicine Physician in Minooka, IL
• Providers in Minooka, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; 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.