1548444540 NPI number — FIDAI MEDICAL CENTER S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548444540 NPI number — FIDAI MEDICAL CENTER S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIDAI MEDICAL CENTER S.C.
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:
1548444540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 N RANDALL RD
Provider Second Line Business Mailing Address:
SUITE 380
Provider Business Mailing Address City Name:
ELGIN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60123-9400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-741-9800
Provider Business Mailing Address Fax Number:
847-741-3058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 N RANDALL ROAD
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-931-8575
Provider Business Practice Location Address Fax Number:
847-931-8581
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHALWANI
Authorized Official First Name:
SHAZLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
847-741-9800

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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