Healthcare Provider Details

I. General information

NPI: 1104898121
Provider Name (Legal Business Name): WEST DUNDEE PHYSICAL MEDICINE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SPRINGHILL RING RD #2005
WEST DUNDEE IL
60118
US

IV. Provider business mailing address

55 E EUCLID AVE STE 460
MT PROSPECT IL
60056-1287
US

V. Phone/Fax

Practice location:
  • Phone: 847-844-7900
  • Fax: 847-844-7941
Mailing address:
  • Phone: 847-222-9060
  • Fax: 847-222-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. VIJAY PATEL
Title or Position: PRESIDENT
Credential: DC
Phone: 847-222-9060