MEDICARE: NORTH SUBURBAN REHABILITATION, LTD.

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	261QM1300X	Multi-Specialty Clinic/Center		IL

General Provider Information

NPI Number	:	1477671667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SUBURBAN REHABILITATION, LTD.

Provider Business Mailing Address
First Line	:	5315 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2531
Country	:	US
Telephone Number	:	773-275-3200
Fax Number	:	773-275-2877

Provider Business Practice Location Address
First Line	:	5315 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2531
Country	:	US
Telephone Number	:	773-275-3200
Fax Number	:	773-275-2877

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LESLIE BULYAKI
Credential	:	D.C.
Telephone Number	:	773-275-3200

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/22/2020

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