Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mamanatandathernizampc

Organization Community Health Clinic/Center · NPI 1104134915

Mamanatandathernizampc is a Community Health Clinic/Center in Chicago, Illinois. Licensed in Illinois. Registered with an NPI since 2010.

Licensed in
IL
In the registry since
2010

Practice location Address checks out

2001 W.69THST
Chicago, IL 60636
Phone: (773) 778-2355
Fax: (773) 788-2355
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community Health Clinic/Center (primary) Taxonomy 261QC1500X · Licence 036-06-9635 (IL)

Record details

NPI number1104134915
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Maimanat Nizam — Physician · (630) 654-1021
NPI enumeratedSeptember 15, 2010
Last updated in NPPESSeptember 15, 2010
Mailing address401 Tamerton Pkwy, Burr Ridge, IL 60527-6347

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