Healthcare Provider Details

I. General information

NPI: 1710374780
Provider Name (Legal Business Name): MEDCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1873 WAUKEGAN RD
GLENVIEW IL
60025-2158
US

IV. Provider business mailing address

PO BOX 76
GLENVIEW IL
60025-0076
US

V. Phone/Fax

Practice location:
  • Phone: 847-724-7600
  • Fax: 847-724-7693
Mailing address:
  • Phone: 847-724-7600
  • Fax: 847-724-7693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036110569
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number70006734
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number56000758
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146007333
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DR. BEA KABBANI
Title or Position: ADMINISTRATOR
Credential: DPT
Phone: 847-724-7600