1285609990 NPI number — MEDICAL ARTS UNLIMITED INC

Table of content: (NPI 1285609990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285609990 NPI number — MEDICAL ARTS UNLIMITED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL ARTS UNLIMITED INC
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:
1285609990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1730 PARK ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-2688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-718-0200
Provider Business Mailing Address Fax Number:
630-718-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E STRONG ST
Provider Second Line Business Practice Location Address:
UNIT #4
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60090-2979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-353-8802
Provider Business Practice Location Address Fax Number:
847-353-8812
Provider Enumeration Date:
02/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAPIRO
Authorized Official First Name:
MISHAIL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
630-718-0200

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0001625426 . This is a "BLUE CROSS / BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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