Provider Demographics
NPI:1871172825
Name:SOUTH LOOP PRIMARY AND URGENT CARE, LLC
Entity type:Organization
Organization Name:SOUTH LOOP PRIMARY AND URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IFTIKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-663-3522
Mailing Address - Street 1:1430 S MICHIGAN AVE UNIT C2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2960
Mailing Address - Country:US
Mailing Address - Phone:312-730-8796
Mailing Address - Fax:
Practice Address - Street 1:1430 S MICHIGAN AVE UNIT C2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2960
Practice Address - Country:US
Practice Address - Phone:312-730-8796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH LOOP URGENT CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center