Healthcare Provider Details

I. General information

NPI: 1902695497
Provider Name (Legal Business Name): MEDIVERSE PROFESSIONAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 MIDWEST RD STE 107
OAK BROOK IL
60523-8201
US

IV. Provider business mailing address

2210 MIDWEST RD STE 107
OAK BROOK IL
60523-8201
US

V. Phone/Fax

Practice location:
  • Phone: 888-632-1240
  • Fax:
Mailing address:
  • Phone: 888-632-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: USMAN KAREEM QADEER
Title or Position: PRESIDENT
Credential: MD
Phone: 574-800-1646