Healthcare Provider Details

I. General information

NPI: 1336295088
Provider Name (Legal Business Name): MIR OBAID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N OAK PARK AVE
CHICAGO IL
60634-1417
US

IV. Provider business mailing address

4200 N OAK PARK AVE
CHICAGO IL
60634-1417
US

V. Phone/Fax

Practice location:
  • Phone: 773-794-4000
  • Fax: 773-794-4046
Mailing address:
  • Phone: 773-794-4000
  • Fax: 773-794-4046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: