Healthcare Provider Details

I. General information

NPI: 1275195059
Provider Name (Legal Business Name): SURE WORK HEALTH CLINIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 N ASHLAND AVE
CHICAGO IL
60622-5684
US

IV. Provider business mailing address

830 N ASHLAND AVE
CHICAGO IL
60622-5684
US

V. Phone/Fax

Practice location:
  • Phone: 312-624-8364
  • Fax:
Mailing address:
  • Phone: 312-624-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEEMA BAYRAN
Title or Position: CEO
Credential: MD
Phone: 312-624-8364