Healthcare Provider Details

I. General information

NPI: 1912447442
Provider Name (Legal Business Name): 63RD MEDICAL & SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 W 63RD ST
CHICAGO IL
60629-4604
US

IV. Provider business mailing address

PO BOX 11232
CHICAGO IL
60611-0232
US

V. Phone/Fax

Practice location:
  • Phone: 773-284-9660
  • Fax: 773-284-9676
Mailing address:
  • Phone: 773-284-9660
  • Fax: 773-284-9676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AYOUB SAYEG
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 773-284-9660