Healthcare Provider Details

I. General information

NPI: 1548308380
Provider Name (Legal Business Name): CENTER FOR MINIMALLY INVASIVE THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE SUITE 402
MELROSE PARK IL
60160-1634
US

IV. Provider business mailing address

8600 WEST BRYN MAWR AVE SUITE 850 N
CHICAGO IL
60631
US

V. Phone/Fax

Practice location:
  • Phone: 708-486-2600
  • Fax:
Mailing address:
  • Phone: 708-667-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: PARAMJIT SINGH CHOPRA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-486-2600