| Ninva Medical Group LLC | |
|
8780 W Golf Rd Ste 303 Niles IL 60714-5611 | |
| (847) 813-6579 | |
| Not Available |
| Full Name | Ninva Medical Group LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 8780 W Golf Rd Ste 303, Niles, Illinois |
| Authorized Official Name and Position | Dany Mamou (OWNER) |
| Authorized Official Contact | 7734121234 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ninva Medical Group LLC 8780 W Golf Rd Ste 303 Niles IL 60714-5611 | Ninva Medical Group LLC 8780 W Golf Rd Ste 303 Niles IL 60714-5611 Ph: (847) 813-6579 |
| NPI Number | 1841963881 |
|---|---|
| Provider Enumeration Date | 07/27/2021 |
| Last Update Date | 07/27/2021 |
| Certification Date | 07/27/2021 |
| Medicare PECOS PAC ID | 3678963113 |
|---|---|
| Medicare Enrollment ID | O20211124000577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841963881 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Dany Mamou |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679704100 PECOS PAC ID: 2961653092 Enrollment ID: I20170526000586 |
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