MEDICARE: FIDAI MEDICAL CENTER S.C.

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1548444540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDAI MEDICAL CENTER S.C.

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

Provider Business Practice Location Address
First Line	:	1710 N RANDALL ROAD
Second Line	:	SUITE 230
City	:	ELGIN
State	:	IL
Zip	:	60123
Country	:	US
Telephone Number	:	847-931-8575
Fax Number	:	847-931-8581

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	01/11/2008

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