Healthcare Provider Details

I. General information

NPI: 1548444540
Provider Name (Legal Business Name): FIDAI MEDICAL CENTER S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 N RANDALL ROAD SUITE 230
ELGIN IL
60123
US

IV. Provider business mailing address

1710 N RANDALL RD SUITE 380
ELGIN IL
60123-9400
US

V. Phone/Fax

Practice location:
  • Phone: 847-931-8575
  • Fax: 847-931-8581
Mailing address:
  • Phone: 847-741-9800
  • Fax: 847-741-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAZLEEN SHALWANI
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-741-9800