Healthcare Provider Details

I. General information

NPI: 1306959770
Provider Name (Legal Business Name): UNIFIED PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 OLD ORCHARD RD SUITE 340
SKOKIE IL
60077-1035
US

IV. Provider business mailing address

5215 OLD ORCHARD RD SUITE 340
SKOKIE IL
60077-1035
US

V. Phone/Fax

Practice location:
  • Phone: 847-763-1700
  • Fax: 847-676-6983
Mailing address:
  • Phone: 847-763-1700
  • Fax: 847-676-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JAFAR SHAH-MIRANY
Title or Position: PRESIDENT, CEO
Credential: M.D.
Phone: 847-763-1700