Healthcare Provider Details

I. General information

NPI: 1124202031
Provider Name (Legal Business Name): UNIVERSAL MEDICAL & REHABILITATION CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 W DEVON AVE
CHICAGO IL
60659-1502
US

IV. Provider business mailing address

9120 W GOLF RD
NILES IL
60714-5806
US

V. Phone/Fax

Practice location:
  • Phone: 773-761-9774
  • Fax: 773-761-9878
Mailing address:
  • Phone: 847-390-7122
  • Fax: 847-390-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FATIMA M MOHIUDDIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 18473907122