OrganizationActive
Mamanatandathernizampc.
NPI 1104134915 · Community Health Clinic/Center · Chicago, IL
Provider details
- NPI number
- 1104134915
- Entity type
- Organization
- Primary specialty
- Community Health Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Maimanat Nizam, Physician
- License
- 036-06-9635 (IL)
Practice location
2001 W.69thst.
Chicago, IL 60636
Phone: (773) 778-2355
Fax: (773) 788-2355
Mailing address
401 Tamerton Pkwy
Burr Ridge, IL 60527-6347
Registry dates
- Enumerated
- 2010-09-15
- Last updated
- 2010-09-15
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.