Healthcare Provider Details

I. General information

NPI: 1598804726
Provider Name (Legal Business Name): OCCUPATIONAL MEDICAL CENTER OF CHICAGO SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 W 95TH ST
CHICAGO IL
60643
US

IV. Provider business mailing address

1751 W 95TH ST
CHICAGO IL
60643
US

V. Phone/Fax

Practice location:
  • Phone: 773-239-1400
  • Fax: 773-239-0400
Mailing address:
  • Phone: 773-239-1400
  • Fax: 773-239-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: ALVIN A GOLDBERG
Title or Position: OWNER MEDICAL DIRECTOR
Credential: MD
Phone: 773-239-1400