Healthcare Provider Details

I. General information

NPI: 1780908434
Provider Name (Legal Business Name): CHICAGO ELECTRICAL TRAUMA RESEARCH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4047 W. 40TH STREET
CHICAGO IL
60632
US

IV. Provider business mailing address

4047 W. 40TH STREET
CHICAGO IL
60632
US

V. Phone/Fax

Practice location:
  • Phone: 800-516-8709
  • Fax: 888-221-3183
Mailing address:
  • Phone: 800-516-8709
  • Fax: 888-221-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateIL

VIII. Authorized Official

Name: FARNAZ ABDOLLAHI
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 773-904-0347