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General NPI Number Information
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NPI Number | 1124202031
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Entity Type | Organization
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Legal Business Name | UNIVERSAL MEDICAL & REHABILITATION CENTER, S.C.
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 2828 W DEVON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-1502
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Country | US
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Telephone | 773-761-9774
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Fax | 773-761-9878
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Provider Business Mailing Address
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Address Line | 9120 W GOLF RD
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City | NILES
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State | IL
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Zip | 60714-5806
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Country | US
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Telephone | 847-390-7122
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Fax | 847-390-7115
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FATIMA M MOHIUDDIN
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Credential | M.D.
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Telephone | 18473907122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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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 | 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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