Healthcare Provider Details

I. General information

NPI: 1215049838
Provider Name (Legal Business Name): OAK BROOK CENTER FOR HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 W 22ND ST STE 215
OAK BROOK IL
60523-4661
US

IV. Provider business mailing address

2425 W 22ND ST SUITE 100
OAK BROOK IL
60523-4641
US

V. Phone/Fax

Practice location:
  • Phone: 630-581-5464
  • Fax:
Mailing address:
  • Phone: 630-990-2212
  • Fax: 630-990-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberR355-1014-7206
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016004441
License Number StateIL

VIII. Authorized Official

Name: KIANOOSH JAFARI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 630-990-2212