Healthcare Provider Details

I. General information

NPI: 1265887673
Provider Name (Legal Business Name): OCCUSPECIALIST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 CASS AVE N/A
DARIEN IL
60561-3607
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 W
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 630-286-5300
  • Fax: 630-986-1096
Mailing address:
  • Phone: 972-364-8000
  • Fax: 214-775-4502

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: RAAD YALDO
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 972-364-8000