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General NPI Number Information
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NPI Number | 1043718190
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Entity Type | Organization
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Legal Business Name | DEEN HEALTH SYSTEM LLC
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2611 S LAWNDALE AVE
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City | CHICAGO
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State | IL
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Zip | 60623-4520
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Country | US
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Telephone | 773-521-6666
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Fax | 833-404-2600
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Provider Business Mailing Address
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Address Line | 4909 W DIVISION ST STE 101
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City | CHICAGO
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State | IL
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Zip | 60651-3108
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Country | US
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Telephone | 773-552-1355
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MOHAMED S SIRAJUDEEN
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Credential |
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Telephone | 773-552-1355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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