Provider Demographics
NPI:1568209880
Name:MSO ILLINOIS LLC
Entity type:Organization
Organization Name:MSO ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUAHMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-335-5150
Mailing Address - Street 1:6400 W COLLEGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1789
Mailing Address - Country:US
Mailing Address - Phone:253-335-5150
Mailing Address - Fax:253-984-1079
Practice Address - Street 1:6400 W COLLEGE DR STE 100
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1789
Practice Address - Country:US
Practice Address - Phone:253-335-5150
Practice Address - Fax:253-984-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty