Healthcare Provider Details

I. General information

NPI: 1912200536
Provider Name (Legal Business Name): EMERGENCY ROOM PROVIDERS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 E 93RD ST
CHICAGO IL
60617-3983
US

IV. Provider business mailing address

2000 SPRING RD SUITE 200
OAK BROOK IL
60523-1804
US

V. Phone/Fax

Practice location:
  • Phone: 773-967-2000
  • Fax:
Mailing address:
  • Phone: 630-472-8800
  • Fax: 630-472-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PIERRE E. WAKIM
Title or Position: PRESIDENT
Credential: D.O.
Phone: 630-472-8800