1063653905 NPI number — MIDWEST PULMONARY & SLEEP CLINIC

Table of content: (NPI 1063653905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063653905 NPI number — MIDWEST PULMONARY & SLEEP CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST PULMONARY & SLEEP CLINIC
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:
1063653905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
802 E WOODFIELD RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SCHAUMBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60173-4712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-240-9500
Provider Business Mailing Address Fax Number:
847-240-9501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1442 MERCHANT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALGONQUIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60102-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-658-0909
Provider Business Practice Location Address Fax Number:
847-658-6709
Provider Enumeration Date:
03/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SAKKA
Authorized Official First Name:
NIDAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-240-9500

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  036108121 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036108121 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 212072 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1635330 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com