MEDICARE: PULMONARY, CRITICAL CARE & SLEEP ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
3	207RP1001X	Pulmonary Disease Physician	036115896	IL

General Provider Information

NPI Number	:	1366839854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY, CRITICAL CARE & SLEEP ASSOCIATES

Provider Business Mailing Address
First Line	:	902 SAINT STEPHENS GRN
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-2568
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 SAINT STEPHENS GRN
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-2568
Country	:	US
Telephone Number	:	914-275-3824
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NUREAIN MIRZA
Credential	:
Telephone Number	:	630-310-8477

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	05/09/2015

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