Healthcare Provider Details

I. General information

NPI: 1083624837
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH CENTERS OF ILLINOIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EAST 103RD STREET
CHICAGO IL
60628
US

IV. Provider business mailing address

5080 SPECTRUM DRIVE SUITE 1200 WEST
ADDISON TX
75001-4625
US

V. Phone/Fax

Practice location:
  • Phone: 773-468-2963
  • Fax: 773-468-2975
Mailing address:
  • Phone: 800-232-3550
  • Fax: 972-387-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAAD A YALDO
Title or Position: VICE PRESIDENT
Credential: DO
Phone: 972-364-8000