Healthcare Provider Details

I. General information

NPI: 1881931046
Provider Name (Legal Business Name): M S HOSPITALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2013
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W 68TH ST HOLY CROSS HOSPITAL
CHICAGO IL
60629-1813
US

IV. Provider business mailing address

5650 N KILBOURN AVE
CHICAGO IL
60646-5912
US

V. Phone/Fax

Practice location:
  • Phone: 773-884-9000
  • Fax:
Mailing address:
  • Phone: 773-814-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036102808
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036102808
License Number StateIL

VIII. Authorized Official

Name: DR. MOHAMMED R SHABBIR
Title or Position: PRESIDENT
Credential: MD
Phone: 773-814-2844