1063671824 NPI number — DR SELMA ARAIN LTD

Table of content: BRIAN D. VASICEK P.T. (NPI 1265738447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063671824 NPI number — DR SELMA ARAIN LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR SELMA ARAIN LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063671824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4403 W LAWRENCE AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60630-2513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-736-1555
Provider Business Mailing Address Fax Number:
773-736-1552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4403 W LAWRENCE AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60630-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-736-1555
Provider Business Practice Location Address Fax Number:
773-736-1552
Provider Enumeration Date:
06/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ARAIN
Authorized Official First Name:
SELMA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT CEO
Authorized Official Telephone Number:
773-736-1555

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036111824 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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