Healthcare Provider Details

I. General information

NPI: 1700227014
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH CENTERS OF ILLINOIS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 S ASHLAND AVE SUITE 110
CHICAGO IL
60608-6251
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST
ADDISON TX
75001-4624
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-5516
  • Fax: 214-775-4502
Mailing address:
  • Phone: 972-364-8000
  • Fax: 214-775-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAAD YALDO
Title or Position: SENIOR VP/CHIEF OFFICER
Credential: DO
Phone: 972-364-8000